入院肾小球滤过率对ST段抬高心肌梗死患者急诊介入治疗术后心肌灌注及预后的影响

Effect of admission estimated glomerular filtration rate on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

目的评价入院估算的肾小球滤过率(eGFR)对接受急诊PCI治疗的ST段抬高型心肌梗死(STEMI)患者冠状动脉血流和预后的影响。方法回顾性收集因STEMI而在12h内接受急诊PCI治疗的患者495例。根据患者入院时eGFR分为两组:eGFR≥60ml·min-1·1.73m-2组和eGFR<60ml·min-1·1.73m-2组。比较两组患者的临床资料、介入手术资料和1年随访资料。结果 eGFR<60ml·min-1·1.73m-2组96例,eGFR≥60ml·min-1·1.73m-2组399例。与eGFR≥60ml·min-1·1.73m-2组相比,eGFR<60ml·min-1·1.73m-2组患者入院时年龄更大,男性患者更多,多支病变患者更多,高血压患者更多,既往心肌梗死病史患者增加,入院及出院eGFR更低,Killip's分级更高。eGFR<60ml·min-1·1.73m-2组校正TIMI计帧数比eGFR≥60ml·min-1·1.73m-2组更高,并且TIMI心肌灌注分级(TMP)0～1级患者更多(5.0%比14.6%)。入院eGFR<60ml·min-1·1.73m-2是接受急诊PCI的STEMI患者心肌灌注不良(校正相对危险度OR=3.95,95%CI:1.23～6.89)和1年死亡率(校正OR=1.48,95%CI:1.21～2.97)的独立预测因子。结论入院eGFR下降与急诊PCI治疗的STEMI患者心肌灌注不良和预后不良相关。

Objective To evaluate the effects of admission estimated glomerular filtration rate （eGFR） on coronary blood flow and prognosis in ST-segment elevation myocardial infarction （STEMI） patients undergoing primary percutaneous coronary intervention （PCI）. Methods A total of 495 patients undergoing primary PCI for STEMI within 12 hours after symptom onset were studied. Patients were divided into two groups according to admission eGFR： eGFR≥60 ml.min-1 .1.73 m-2 group （n =399） and eGFR 〈 60 mL.min-1.1.73 m-2 group （n = 96）. Results Univariate analyses showed statistical differences between eGFR≥60 and eGFR 〈 60 ml.min-1. 1.73 m-2 groups in age, gender, number of diseased vessels, hypertension, previous MI, admission eGFR and Killip＇ s grades on presentation （ P 〈 0.05 ）. Corrected TIMI frame count （CTFC） in the eGFR 〈 60 ml.min-1 .1.73 m-2 group was more than in the eGFR~〉60 ml.min-^- 1.73 m-2 group, and TIMI myocardial perfusion grades （TMPG） 0 -1 were more frequent （5.0% and 14. 6%, P 〈 0. 05）. Admission eGFR 〈 60 ml. min- 1.1.73 m-2 was an independent predictor of poor myocardial perfusion [adjusted odds ratio （OR） 3.95; 95% confidence interval （CI）： 1.23 - 6. 89 ] and a higher rate of 1-year mortality in STEMI patients undergoing primary PCI （ adjusted OR 1.48; 95% CI： 1.21 -2.97 ）. Conclusions The decreased admission eGFR is associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI.