老年终末期肾病血液透析患者接受药物洗脱支架置入治疗的临床特点和预后分析

Clinical characteristics and prognosis of elderly hemodialysis patients with end-stage renal disease undergoing drug-eluting stent implantation

目的评估终末期肾病(ESRD)血液透析对老年患者接受药物洗脱支架(DES)置入治疗预后的影响。方法回顾性连续选取2003年3月至2021年7月于韩国高丽大学附属九老医院行DES治疗的年龄>60岁的患者4219例,将估算肾小球滤过率≥15ml/(min·1.73m^(2))且未接受透析治疗的4102例作为老年非ESRD组,接受透析治疗的117例作为老年ESRD组,依据2组患者基线资料建立倾向性评分匹配(PSM)模型,PSM后老年非ESRD组183例,老年ESRD组99例。随访1年、3年、5年,记录主要不良心血管事件(MACE)等临床终点事件,绘制Kaplan-Meier生存曲线,用PSM和多因素Cox回归验证临床终点事件。结果PSM前老年ESRD组合并高血压、糖尿病、外周血管疾病、其他诊断比例高于老年非ESRD组(P<0.01)。Cox单因素回归分析显示,老年ESRD是行DES置入患者术后1年、3年、5年发生全因死亡的危险因素(P<0.05,P<0.01);老年ESRD是行DES置入患者术后3年、5年发生MACE的危险因素(HR=2.67,95%CI:1.73~4.10,P=0.000;HR=2.65,95%CI:1.79~3.90,P=0.000);老年ESRD是行DES置入患者术后5年发生TVR、TLR、NTVR和血运重建的危险因素(P<0.05,P<0.01)。Kaplan-Meier生存曲线显示,老年ESRD组无MACE生存率降低(80.0%vs 90.2%,Plog rank=0.006)。结论ESRD显著增加老年DES置入患者术后长期MACE的风险。

Objective To evaluate the effect of end-stage renal disease(ESRD)hemodialysis(HD)on the prognosis of elderly patients undergoing drug-eluting stent(DES)implantation.Methods A retrospective trial was conducted on 4219consecutive patients(>60years old)undergoing DES treatment at Guro Hospital of Korea University from March 2003to July 2021,and those with GFR≥15ml/(min·1.73m^(2))but not on dialysis were assigned into the non-ESRD group(n=4102)and the others on dialysis into the ESRD group(n=117).Based on their baseline data,a propensity score matching(PSM)model was established,including 183cases of the non-ESRD group and 99cases of the ESRD group.The patients were followed up for 1,3and 5years,and the incidences of MACE and other endpoint events were recorded during the period.Kaplan-Meier survival curve was plotted,and PSM and multivariate Cox regression models were employed to verify the endpoint events.Results Before PSM,the elderly ESRD group had obviously larger proportions of hypertension,diabetes,peripheral vascular disease and other diagnoses than the elderly non-ESRD group(P<0.01).Univariate Cox regression analysis showed that ESRD was a risk factor for all-cause mortality in the elderly patients at 1,3and 5years after DES implantation(P<0.05,P<0.01);a risk factor for MACE at 3and 5years after implantation(HR=2.67,95%CI:1.73-4.10,P=0.000;HR=2.65,95%CI:1.79-3.90,P=0.000);and a risk factor for developing TVR,TLR,NTVR and revascularization at 5years after surgery(P<0.05,P<0.01).Kaplan-Meier survival curve showed that the incidence of MACE in the elderly ESRD group was higher than that in the elderly non-ESRD group at 5-year follow-up(Plog rank=0.006).Conclusion ESRD significantly increases the risk of long-term MACE after DES implantation in elderly patients.