急性冠状动脉综合征合并肾功能不全的支架术治疗

Coronary stenting in patients with acute coronary syndrome and renal dysfunction

目的 评估急性冠状动脉 (冠脉 )综合征合并肾功能不全患者经皮腔内支架术的预后。方法 6 3例急性冠脉综合征合并肾功能不全行冠脉内和或肾动脉支架植入术患者 (肾功能不全组 ) ,随机选取同期 6 3例一般情况匹配 ,肾功能正常行介入治疗患者 (对照组 )。比较两组临床特征、血管造影、支架术及随访情况。结果 肾功能不全组患者血清肌酐水平显著增高 [(177± 31) μmol/L比(98± 2 1) μmol/L ,P <0 0 0 1]、左室射血分数减低 (0 4 5± 0 10比 0 5 0± 0 0 9,P <0 0 5 ) ,冠脉多支病变增多 (84 %比 6 5 % ,P <0 0 5 )且肾动脉狭窄发生率显著增高 (2 7%和 8% ,P <0 0 5 ) ,13例患者在冠脉支架术同时行肾动脉支架术 (比较对照组 2例 ,P <0 0 5 ) ;两组冠脉支架术手术成功率和术中并发症相似 ;随访表明 ,肾功能不全组严重心脏不良事件发生率较高 (13%和 8% ,P =0 38) ,平均血清肌酐水平较术前降低 (177± 31μmol/L和 14 7± 11μmol/L ,P <0 0 5 ) ,9例 (6 9% )肾动脉狭窄患者肾动脉支架术后血清肌酐恢复正常。结论 急性冠脉综合征合并肾功能不全患者冠脉支架术安全、有效 ,2 / 3接受肾动脉支架术患者术后血清肌酐恢复正常。

Objective To evaluate the immediate and mid-term efficacy of coronary stenting in patients with acute coronary syndrome (ACS) and renal dysfunction. Methods Sixty-three ACS patients with renal dysfunction were included (RD group) and 63 contemporaneous ACS patients with normal renal function served as a control group. The clinical characteristics, stenting procedure and follow-up information were compared between the two groups. Results Patients in the RD group had higher basic serum creatinine levels [(177±31) μmol/L vs (98±21) μmol/L, P <0.001], lower left ventricular ejection fraction (0.45±0.10 vs 0.50±0.09, P <0.05) and increased prevalence of multivessel coronary artery disease (84% vs 65%, P <0.05) as well as >50% renal artery stenosis (27% vs 8%, P <0.05). There was no statistical difference in procedural success rate and major adverse cardiac events occurrence during a mean follow up time of 27 months (13% vs 8%, P =0.38). In the RD group, the mean level of serum creatinine was significantly decreaed [(177±31) μmol/L vs (147±11) μmol/L, P <0.05] and 9(69%) patients with renal artery stent implantation had normal creatinine levels during follow-up. Conclusions Coronary stenting is a safe and effective therapy for ACS patients complicated with renal dysfunction,two thirds of patients receiving renal stent implantation had normal serum creatinine during follow-up.