－S 442 －
― S-183 ―
Impact of Diabetes Mellitus on the Long-Term Outcomes in the Drug-Eluting Stents Era
울산대학교 의과대학, 서울아산병원
*이정우, 박덕우, 김원장, 김경중, 박종필, 이종영, 이승환, 김영학, 이철환, 홍명기, 김재중, 박성욱, 박승정
Background: Patients with diabetes are prone to a aggressive form of atherosclerosis and have known to have a higher incidence of mortality and morbidity compared with non-diabetic patients. Data are limited regarding the influence of diabetes on the long-term effectiveness and safety of drug-eluting stents (DES). Methods: This study compares the long-term outcomes of 865 diabetic patients to 2295 non-diabetic patients treated with DES. The primary endpoint was the composite of death, myocardial infarction (MI), or target vessel revascularization (TVR). Results: Diabetic patients had a significant higher risk profile than non-diabetic patients (old age, a higher incidence of hypertension, renal failure, previous bypass surgery, complex lesions, and multivessel disease, and longer stent length per patients). After risk adjustment, there was no difference in the overall risk of death (adjusted hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.49-1.11) or MI (HR 1.06; 95% CI, 0.50-2.22) up to 3 years. However, there was a significant increase of TVR in diabetic patients, as compared with non-diabetic patients (10.5% vs. 3.8%, HR 2.34; 95% CI, 1.47-3.74; P<0.001). At 3 year, the incidence of the primary end-point was significantly higher in diabetic patients (16.3% vs. 10.4%, HR 1.64; 95% CI, 1.27-2.11; P<0.001). The independent predictors of the composite endpoint was lower ejection fraction (P=0.015), renal failure (P=0.003), and diabetes (P<0.001). Conclusions: Diabetes has a significant detrimental effect on the long-term outcomes, especially repeat revascularization, of patients treated with DES.
― S-184 ―
A case of multi-vessel myocardial bridging
인제대학교 부산백병원 심장내과
*한양천, 김두일, 노은지, 박영진, 김기훈, 설상훈, 양태현, 김성만, 김대경, 김동수
Introduction: Myocardial bridging is defined as a segment of a major epicardial coronary artery that goes intramurally through the myocardium beneath the muscle bridge, and mostly confined to the left anterior descending artery. Case: A 47-year-old man was admitted to our hospital complaining of effort chest pain that had lasted for 1 month. His risk factor was current smoking. The ECG showed anteroextensive myocardial ischemia and echocardiogram was normal. The left coronary angiogram showed multi-vessel myocardial bridge of mid left anterior descending artery(LAD) and distal left circumflex artery(LCX). Intravascular ultrasound (IVUS) showed the specific ‘half- moon’ like echolucent area in the bridged segment. The right coronary angiogram showed normal. The patient received ß-blocker and has remained asymptomatic during 9 months follow-up. Conclusion: We present a rare case who experienced multivessel myocardial bridging at the LAD and LCX, which was evaluated with IVUS and coronary angiography.
