冠心病合并慢性肾功能不全患者的临床特征和PCI远期预后分析

Clinical characteristics and long-term outcome of PCI in patients with chronic renal insufficiency

目的测定冠心病合并慢性肾功能不全(CRI)患者的临床特征,并探讨药物洗脱支架对这些患者冠状动脉介入治疗(PCI)的主要不良事件发生率和临床远期预后的作用。方法973例经冠状动脉造影确诊冠状动脉明显狭窄(管腔内径减少＞50%)中,516例合并肾功能不全(CRI组),457例肾功能正常(对照组)。记录两组基础临床和造影情况,每例均接受PCI治疗和术后临床随访。结果CRI组高龄、高血压及糖尿病患者明显多于对照组,但左室射血分数显著低于对照组。CRI组冠状动脉复杂病变(C型)明显多于对照组。平均17个月随访结果显示,CRI组总病死率高于对照组(6．2%和3．3%,P＜0．05)。亚组分析显示,CRI患者药物洗脱支架治疗后病死率低于普通支架(4．1%和8．5%,P＜0．05)。结论CRI患者通常冠状动脉病变严重,PCI后病死率明显增加,但药物洗脱支架较普通支架显著改善远期预后。

Objective To determine clinical characteristics and the effects of drug-eluting stents on the occurrence of major adverse cardiac events during percuteneous coronary artery interventional （PCI）and longterm outcomes in patients with chronic renal insufficiency （CRI）. Methods Nine hundreds and seventy three patients with angiographically-documented coronary artery disease （lumen inner diameter narrowing 〉 50%）, included 516 patients complicated with experienced renal impairment （CRI group）and 457 with normal renal function （control group）. Baseline clinical data and coronary angiographic features were recorded. Results Comparing with control group, patients in CRI group were older with higher incidence of hypertension or diabetes and simultaneously complicated by reduced left ventricular ejection fraction, and more complex coronary lesions （type C）. During follow-up（mean 17 months）, the mortality was significantly higher in CRI than in control group （6.2% vs 3.3%, P 〈 0.05）, but the former with CRI was significantly lower by using drug-eluting stents in comparing with bare-metal stents（4.1% vs 8.5%, P 〈 0.05）. Conclusion Patients with CRI often complicated with severe coronary artery disease, the mortality after PCI would be significantly reduced by using drug-eluting stents.