慢性肾功能不全对ST段抬高型心肌梗死合并多支血管病变的临床预后影响

The impact of chronic renal dysfunction on clinical prognosis of ST-segment elevation myocardial infarction with multivessel disease

目的:探讨慢性肾功能不全对于急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者的院内及5年远期临床预后的影响。方法:连续入选2005年至2015年,首都医科大学附属北京安贞医院,STEMI合并多支血管病变患者1032例,根据简化的肾脏病饮食改良公式(MDRD)估算肾小球滤过率(eGFR)。分为两组,其中eGFR<60 mL·min^-1·1.73m^-2患者96例,为肾功能不全组;eGFR≥60 mL·min^-1·1.73m^-2患者936例,为肾功能代偿组。分析比较两组的基线特点,院内及5年随访的心血管不良事件。结果:在1032例患者中,肾功能不全组96例(9.3%)。其中肾功能不全组的年龄、女性占比、既往支架置入史、BNP和住院天数均高于肾功能代偿组(P<0.05),吸烟比例在肾功能不全组较低(P=0.002)。肾功能不全组的院内死亡率(4.2%vs.0.7%,P=0.002)、5年死亡率(12.5%vs.2.2%,P<0.001)及脑卒中发生率(4.2%vs.1.2%,P=0.039)均显著高于肾功能代偿组;而肾功能代偿组具有更高的再次血运重建率(14.3%vs.7.3%,P=0.038)。慢性肾功能不全是STEMI合并多支血管病变5年主要不良心脑血管事件的危险因素(HR=3.379,95%CI:1.200~9.516,P=0.021)。结论:慢性肾功能不全使STEMI合并多支血管病变患者死亡率显著增高,是STEMI合并多支血管病变患者长期MACCE的危险因素。

Objective:To investigate the effects of chronic renal dysfunction on in-hospital and 5-year long-term outcome of patients of acute ST-segment elevation myocardial infarction(STEMI)with multivessel disease.Methods:A total of 1032 patients with STEMI with multivessel disease in Beijing Anzhen Hospital affiliated to Capital Medical University from 2005 to 2015 were continuously selected,and the glomerular filtration rate(eGFR)was estimated based on the simplified MDRD equation.Divided into two groups,There were 96 cases of renal dysfunction group(eGFR<60 mL·min^-1·1.73m^-2);There were 936 cases of renal function preservation(eGFR≥60 mL·min^-1·1.73m^-2).Analyze and compare the baseline characteristics and cardiovascular adverse events in the hospital and at the 5-year follow-up.Results:Among the 1032 patients,96(9.3%)were in the renal dysfunction group.Among them,the age of the renal insufficiency group,the proportion of women,the history of previous stent implantation,BNP,and the length of hospital stay were higher than those in the renal compensation group(P<0.05),and the smoking rate was lower in the renal insufficiency group(P=0.002).In-hospital mortality(4.2%vs.0.7%,P=0.002),5-year mortality(12.5%vs.2.2%,P<0.001),and stroke incidence(4.2%vs.1.2%,P=0.039)in the renal dysfunction group were significantly higher than the renal function preservation group;the renal function preservation group had a higher revascu-larization rate(14.3%vs.7.3%,P=0.038).Chronic renal dysfunction is an independent risk factor for 5-year MACCE in STEMI with multivessel disease(HR=3.379,95%CI:1.200~9.516,P=0.021).Conclusions:Chronic renal dysfunction significantly increases the mortality of patients of STEMI with multivessel disease.Chronic renal dysfunction is an independent risk factor for long-term MACCE in patients of STEMI with multivessel disease.