介入治疗左主干病变合并肾功能轻度下降患者的预后分析

Outcomes after percutaneous cororary intervention for left main coronary artery and mildly impaired renal function

目的:本研究旨在研究经皮冠状动脉介入术(PCI)治疗左主干病变合并肾功能轻度下降患者的预后。方法:入选北京安贞医院行PCI治疗左主干病变合并肾小球滤过率(eGFR)>60mL·min^(-1)·1.73m^(-2)的患者,分为两组:CKD1期(肾功能正常组):eGFR>90mL·min^(-1)·1.73m^(-2),CKD2期(肾功能轻度下降组):eGFR在60~89 mL·min^(-1)·1.73m^(-2)之间。研究终点包括全因死亡/心肌梗死/卒中联合终点、全因死亡、心肌梗死、卒中、再次血运重建。结果:共入选患者801例,CKD1期410例,CKD2期391例,随访时间中位数5.6(4.4,6.8)年,校正前CKD1期和CKD2期两组间不良事件发生率如下:全因死亡/心肌梗死/卒中(7.3%vs.14.8%,P=0.001)、全因死亡(3.2%vs.8.2%,P=0.002)、卒中(1.5%vs.4.1%,P=0.032)、心肌梗死(4.6%vs.6.9%,P=0.202)、再次血运重建(23.9%vs.22.8%,P=0.995)。Cox多因素校正分析后,校正后各终点差异与校正前趋势相同。结论:肾功能轻度下降的左主干病变患者行PCI治疗较肾功能正常的患者预后差。

Objective:To evaluate the outcomes of patients treated with percutaneous coronary intervention(PCI)for left main coronary artery lesions and mildly impaired renal function.Methods:801 patients with lesions in unprotected left main coronary artery and eGFR>60mL·min^(-1)·1.73m^(-2) were enrolled who underwent PCI in Beijing AnZhen Hospital.The endpoints of the study were death,repeat revascularization,myocardial infarction(MI),stroke and the composite of death,MI and stroke.Results:From January 2003 to July 2009,801 patients with unprotected left main coronary artery disease and eGFR>60 mL·min^(-1)·1.73^(-2)m were enrolled in Beijing An Zhen Hospital(CKD 1 stage 410 vs.CKD 2 stage 391).The median follow-up was 5.6(4.4,6.8)years in the overall patients.The crude relative risk are as follows.The occurrences of death(CKD 1 stage 3.2%vs.CKD 2 stage 8.2%,P=0.002),stroke(CKD 1 stage 1.5%vs.CKD 2 stage 4.1%,P=0.032)and composite of serious outcomes(death,MI,or stroke)(CKD 1 stage 7.3%vs.CKD 2 stage 14.8%,P=0.001)were significantly higher with the CKD 2 stage group.No significant difference was observed in the rate of MI(CKD 1 stage 23.9%vs.CKD 2 stage 22.8%,P=0.202)and repeart revascularization(CKD 1 stage 1.5%vs.CKD 2 stage 4.1%,P=0.995)between the two groups.After multivariate analysis,the trends were the same as the unadjusted results.Conclusions:Compared to the normal renal function and left main coronary artery disease treated with PCI,patients with mildly impaired renal function suffered poorer prognosis.