1

1 : Evidence Based Medicine: 2 1 .

3 Harrisons Principles of Internal Medicine, 17th EditionGoldman : Cecil Medicine, 23rd EditionBraunwalds Heart Disease, A Textbook of Cardiovascular Medicine, 8th EditionJoseph T. Dipiro et al. Pharmacotherapy, 6th Edition, 2005 Goetz : Textbook of Clinical Neurology, 3rd Edition , 5, , 2003. p783 ~ 795. , 2005 p 229 ~ 231.. . , 2007; 71-77. , , 2001ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-Elevation myocardial infarction. Anderson JL, et al. J Am Coll Cardiol 2007 Aug 14;50(7):e1-e157.Richard C. et al. The Primary and Secondary Prevention of Coronary Artery Disease : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), Chest 2008;133;776-814 DOI 10.1378/chest.08-0685Bassand JP, et al. Task Force for Diagnosis and Treatment of Non-ST- Segment Elevation Acute. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007 Jul;28(13):1598-660.National Institute for Clinical Excellence (NICE). Clopidogrel in the treatment of non-ST-segment-elevation acute coronary syndrome. London (UK): National Institute for Clinical Excellence (NICE); 2004 Jul. 24 p. (Technology appraisal; no. 80).Scottish Intercollegiate Guidelines Network (SIGN). Acute coronary syndromes. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2007 Feb. 53 p. (SIGN publication; no. 93)2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Circulation 2008;117;296-329 DOI: 10.1161/ CIRCULATIONAHA.107.188209Frans Van de Werf, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology, European Heart Journal (2008) 29, 2909-29452007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 20054Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation. 2008 Jan 15;117(2):261-95.Silber S, et al. Guidelines for percutaneous coronary interventions: the Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 2005 Apr;26(8):804-47.Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack, Stroke 2008;39(5):1647-1652.Gregory W. et al. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), Chest 2008;133;630-669 DOI 10.1378/chest.08-0720 Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008, The European Stroke Organization(ESO) Executive Committee and the ESO Writing Committee, Cerebrovasc Dis 2008;25(5):457-507.Adams HP Jr, et al, Guidelines for the early management of adults with ischemic stroke. A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 2007 May;38(5):1655-711.Sacco RL, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006 Feb;37(2):577-617.National clinical guidelines for stroke Second edition, ROYAL COLLEGE OF PHYSICIANS(UK) June 2004 Yukito Shinohara and Takenori Yamaguchi, Outline of the Japanese Guidelines for the Management of Stroke 2004 and subsequent revision, International Journal of Stroke Vol 3, February 2008, 55-62.Michael Sobel, et al. Antithrombotic Therapy for Peripheral Artery Occlusive Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), Chest 2008;133;815-843 DOI 10.1378/chest.08-0686Norgren L, et al. Inter-Society Consensus for the Management of peripheral arterial disease (TASC ). Int Angiol 2007;26(2):81-157ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Trans Atlantic Inter-Society Consensus; and Vascular Disease Foundation, Circulation. 2006 Mar 21;113(11):e463-654.Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular events. National Institute for Health and Clinical Excellence (NICE); 2005 May. 34 p.Management of Peripheral Arterial Disease, A peer-reviewed journal of the American Academy of Family Physicians February 1, 2004Expert consensus document on the use of antiplatelet agents. The Task Force on the Use of Antiplatelet Agents in Patients with Atherosclerotic Cardiovascular Disease of the European Society of Cardiology. Eur Heart J 2004 Jan;25(2):166-81.

5Work RVUSingle VesselTwo VesselThree VesselBalloon10.9613.93 (1.27)16.9 (1.54)Stent14.8218.98 (1.28)23.14 (1.56)Single VesselTwo VesselThree VesselBalloon/Stent44,00060,000 (1.364)76,000 (1.73)Single VesselTwo VesselThree VesselPCI222222Single VesselTwo VesselBalloon11.5Stent11.5 6Adjuctive Ballooning 30% 2 1.0mm ( ) 30% 1.0mm

7(DEB) 2.5-3.0mm

8 (%)() () 69.8 3.2 223.5 69.8 5.0 349.2 56.3 , 69.8 6.1 428.8 90.8 5.2 471.4 9.9 , 111.7 5.2 579.6 145.0 5.2 752.6 29.8 , 90.0 5.3 472.5 155.0 5.3 813.8 72.2 , +160.0 4.0 638.4 160.0 5.2 830.4 30.1 , 50.2 2.3 115.9 45.0 5.2 233.6 101.5 , 69.8 2.3 162.7 69.8 5.2 362.4 122.7 , +80.0 2.2 179.2 80.0 5.2 415.2 131.7 , 98.3 7.8 766.0 150.0 7.8 1168.5 52.5 , 60.0 12.6 755.4 120.0 9.4 1131.6 49.8 , 60.0 10.5 631.8 130.0 6.3 821.6 30.0 350.0 1.8 637.0 150.0 4.7 703.5 10.4 49.0 2.7 133.3 49.0 3.2 157.8 18.4 9 10 () () . .11 : : , : 2007.7.1 2010.12.31: 5, : 1 : 1%12

13

14 (/10)

15

16

17

18

19

20

21

22

23 2008 2009

24 (I)

25 (II)

26

27

28

29 --

30

31

32

33

34 (2012 )

2011 8 2012 35

36 -2011 - : 60 30 Primary PCI : 120 90 5 91 2%, 2 1% 1% , 9 2% 37 : / 5 9/ : : 38 ( )

39