肾功能下降对行血运重建术左主干病变患者的长期预后影响

The effect of chronic kidney disease on the long-term prognosis of patients with left main coronary artery disease after revascularization

目的分析慢性肾脏病对行血运重建术左主干病变患者的长期生存影响。方法以2003年1月至2009年7月在北京安贞医院心内科或心外科行经皮冠状动脉介入术(PCI)或者冠状动脉旁路移植术(CABG)治疗的无保护左主干病变患者为研究对象,共1040例,其中慢性肾脏病(CKD)组240例,年龄为(68.9±6.5)岁,无CKD组800例,年龄为(61.1±9.7)岁。采用心内科门诊或电话方式对患者进行随访,随访终点为全因死亡、心肌梗死、卒中;分析两组患者生存率,并采用多因素Cox比例风险回归模型分析患者生存的影响因素。结果共纳入患者1040例,随访时间[M(Q1,Q3)]为6.1(5.1,8.0)年。CKD组全因死亡、心肌梗死、卒中联合发生率(48.9%,96例)高于无CKD组(30.7%,136例)(P<0.001)。CKD组中,行PCI和CABG的患者全因死亡、心肌梗死、卒中联合发生率分别为51.2%(46例)和47.2%(50例)(P=0.662);无CKD组中,行PCI和CABG的患者全因死亡、心肌梗死、卒中联合发生率分别为17.7%(45例)和36.7%(91例)(P=0.107)。Cox比例风险回归模型分析显示,调整了混杂因素后,合并CKD患者血运重建术后全因死亡、心肌梗死、卒中联合[HR(95%CI):1.97(1.49~2.62)]、全因死亡[HR(95%CI):2.67(1.89~3.78)]、心源性死亡[HR(95%CI):3.46(2.25~5.33)]、心肌梗死[HR(95%CI):2.31(1.41~3.80)]发生风险上升。结论对于左主干病变行血运重建的患者,合并CKD增加全因死亡、心肌梗死、卒中联合发生率,全因死亡率,心源性死亡率和心肌梗死发生率。不论是否合并CKD,PCI和CABG治疗左主干病变两组全因死亡、心肌梗死、卒中联合发生率差异无统计学意义。

Objective To analyze the effect of chronic kidney disease(CKD)on the long-term prognosis of patients with left main coronary artery disease after revascularization.Methods A total of 1040 patients with lesions in unprotected left main coronary artery who underwent percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG)between January 2003 and July 2009 in Beijing An Zhen Hospital were enrolled(CKD group,n=240;non CKD group,n=800).The mean ages of CKD group and non CKD group were(68.9±6.5)and(61.1±9.7)years old,respectively.Patients were followed up through interviewing in clinic visit or calling by telephone.The primary endpoints of the study included death,myocardial infarction(MI)and stroke.Cox regression was used to analyze the associated factors on patients′long-term prognosis.Results The median follow-up for included 1040 patients was 6.1 years(first quartile Q1,5.1 years;Q3,8.0 years).The total occurrence of death,MI and stroke in the CKD group(48.9%,n=96)was significantly higher than that in the non CKD group(30.7%,n=136)(P<0.001).In the CKD group,the total occurrence of the death,MI and stroke was 51.2%in patients with PCI(n=46)compared to that of 47.2%in patients with CABG(n=50).In the non CKD group,the total occurrence of death,MI and stroke was 17.7%and 36.7%in patients with PCI(n=45)and CABG(n=91),respectively.Cox proportional hazards regression model analysis showed that after adjusted for confounding factors,the risk of all-cause death/MI/stroke[HR(95%CI):1.97(1.49-2.62)],all-cause death[2.67(1.89-3.78)],cardiac death[3.46(2.25-5.33)]and MI[2.31(1.41-3.80)]increased in patients with CKD after revascularization.Conclusions CKD significantly increases the occurrence of composite of death/MI/stroke,all-cause mortality,cardiac death and MI in patients with left main coronary artery disease after revascularization.There was no significant difference in the occurrence of the composite of death,MI and stroke between patients with PCI and those with CABG,regardless of in CKD group or non CKD group.