摘要
目的对比合并中度和重度慢性肾脏疾病(CKD)的冠心病(CAD)患者行冠状动脉旁路移植术(CABG)的临床疗效及远期预后。方法采集自2014年1月至2020年6月共850例合并CKD的冠心病患者临床资料,包括561例CKD中度[肾小球滤过率(eGFR):30~60 ml/(min·1.73m^(2))]和289例CKD重度[eGFR<30 ml/(min·1.73m^(2))]患者。收集所有患者住院治疗结果,并完成随访。初级终点时间为全因死亡,次级终点事件包括主要心脑血管事件(MACCE)、再发脑卒中、再发心绞痛、再发心肌梗塞和再次血运重建。结果CKD重度患者术前合并陈旧性心梗和心衰史的比例较高,其余术前基线资料两组间无明显统计学差异。CKD中度和重度组在院死亡率分别为5.5%和6.9%,二者无显著统计学差异(P=0.447)。CKD重度患者术后二次开胸止血(P=0.044)、围术期心梗(P=0.046)及感染(P=0.030)的发生率均高于CKD中度患者;术后新发透析也明显高于CKD中度组(P=0.017)。两组间住院时间及住院费用等无统计学差异。平均随访4(1~7)年,CKD重度组MACCE发生率高于CKD中度组(P=0.001);再发心绞痛(P=0.004)、再次住院(P=0.018)和再次血运重建(P=0.047)均高于中度CKD;两组间生存率无统计学差异(P=0.727)。结论对于合并CKD的冠心病患者,CKD中度和重度患者行CABG的住院死亡率和长期生存率无显著统计学差异;CKD中度患者围术期并发症的发生率及长期随访MACCE的发生率均低于CKD重度组。重度肾功能下降的患者显著增加了CABG术后需要透析治疗的风险。
Objective To compare the clinical results and long-term prognosis of coronary artery bypass grafting(CABG)in coronary heart disease(CAD)patients with moderate or severe chronic renal disease(CKD).Methods The clinical data of 850 CAD patients combined with CKD were collected from January 2014 to June 2020,including 561 patients with moderate CKD(eGFR:30-60 ml/min/1.73m^(2))and 289 patients with severe CKD(eGFR<30 ml/min/1.73m^(2))patients.The perioperative and long-term follow-up results were collected.The primary end point was all-caused death,and the secondary end points included major cardiovascular and cerebrovascular events(MACCE),stroke,angina,myocardial infarction,repeat revascularization and recharge in-hospital.Re⁃sults There was no significant difference in the baseline data between the two groups except the higher proportion of myocardial infarc⁃tion(MI)and heat failure history in the severe CKD group.The in-hospital mortality rates of the moderate and severe CKD groups were 5.5%and 6.9%respectively,without statistically significant difference(P=0.447).The incidence of reoperation for bleeding(P=0.044),perioperative MI(P=0.046)and severe infections(P=0.030)in severe CKD patients were higher than those in moderate CKD patients.The occurrence of new-onset dialysis was also higher in severe CKD patients(P=0.017).There was no sig⁃nificant difference in hospital stay and cost between the two groups.The average follow-up was 4(1-7)years.During the follow-up,the incidence of MACCE in the severe CKD group was higher than that in the moderate CKD group(P=0.001),and the rates of re⁃currence of angina,re-hospitalization and repeat revascularization were also higher than those in the moderate CKD group(P=0.004;P=0.018;P=0.047).There was no statistical difference in the long-term survival rate between the two groups(P=0.727).Con⁃clusion For CAD patients with CHD,the perioperative risk and long-term follow-up results for moderate CKD patients were better than those of severe CKD patients.There was no significant difference in in-hospital mortality and long-term survival rate between the two groups.The risk of new occurred dialysis after CABG procedure increased obviously in the patients with severe CKD.
作者
李扬
侯琮
候雪见
刘韬帅
许士俊
黄柱辉
董然
Li Yang;Hou Cong;Hou Xuejian;Liu Taoshuai;Xu Shijun;Huang Zhuhui;Dong Ran(Coronary Surgery Center,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)
出处
《中国体外循环杂志》
2022年第3期155-159,共5页
Chinese Journal of Extracorporeal Circulation
关键词
冠状动脉旁路移植术
冠心病
慢性肾脏疾病
预后
Coronary artery bypass grafting
Coronary artery disease
Chronic kidney disease
Prognosis