轻度慢性肾脏疾病对冠心病患者PCI术后长期预后的影响

Impact of Mild Chronic Kidney Disease on the Prognosis of Coronary Artery Disease after Percutaneous Coronary Intervention

目的慢性肾脏疾病是影响冠心病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)预后的重要因素之一,既往研究较少关注轻度慢性肾脏疾病(eGFR:60~89 ml/min/1.73m2)的患者。本研究旨在研究大样本患者中轻度慢性肾脏疾病与冠心病PCI术后长期预后的关系。方法本研究入选2013年1月1日至12月31日10270例在阜外医院接受PCI治疗的轻度慢性肾脏疾病患者以及肾功能基本正常(eGFR≥90 ml/min/1.73m2)的患者。研究中选择针对中国人群校准的简化MDRD公式计算患者的eGFR。对研究人群进行平均30个月的随访,终点事件包括全因死亡、心源性死亡、急性心肌梗死、支架内血栓形成、再次血运重建以及全因死亡与急性心肌梗死组成的复合终点事件。结果轻度慢性肾脏疾病是PCI术后长期死亡(HR=1.552,95%CI:1.019-2.362,P=0.041),心源性死亡(HR=1.933,95%CI:1.113-3.356,P=0.019),急性心肌梗死(HR=1.983,95%CI:1.236-3.183,P=0.005),支架内血栓(HR=1.962,95%CI:1.156-3.331,P=0.013)以及全因死亡与急性心肌梗死复合事件(HR=1.562,95%CI:1.104-2.210,P=0.012)的独立危险因素。结论与肾功能正常患者相比,轻度慢性肾脏疾病的冠心病患者行PCI治疗的长期预后不佳。

Objective Although chronic kidney disease is an important prognostic factor of percutaneous coronary intervention(PCI),few previous studies concern about the patients with mild chronic kidney disease(estimated glomerular filtration rate[eGFR]:60-89 ml/min/1.73m2).This study aims to research the association between mild chronic kidney disease and long-term prognosis in a large cohort of patients.Methods A total of 10270 patients with mild chronic kidney disease or normal kidney function(eGFR≥90 ml/min/1.73m2)who underwent PCI in Fuwai Hospital from January 1st,2013 to December 31st,2013 were enrolled in this study.The eGFR was calculated with the Modification of Diet in Renal Disease(MDRD)equations that were corrected in Chinese.Endpoint events included all-cause death,cardiac death,acute myocardial infarction,in-stent thrombosis,target vessel revascularization and the composite endpoint of all-cause death and acute myocardial infarction.Results Mild chronic kidney disease(eGFR:60-89 ml/min/1.73m2)was an independent risk factor of all-cause death(HR=1.552,95%CI:1.019-2.362,P=0.041),cardiac death(HR=1.933,95%CI:1.113-3.356,P=0.019),acute myocardial infarction(HR=1.983,95%CI:1.236-3.183,P=0.005),in-stent thrombosis(HR=1.962,95%CI:1.156-3.331,P=0.013),and the composite end event of all-cause death and myocardial infarction(HR=1.562,95%CI:1.104-2.210,P=0.012).Conclusion Compared to patients with normal kidney function,patients with mild chronic kidney disease have a worse long-term prognosis after PCI.