Asinger R W, Henry T D, Herzog C A, Paulsen P R, Kane R L
Cardiology Division 865A, Hennepin County Medical Center, 701 Park Avenue S., Minneapolis, MN 55415, USA.
J Invasive Cardiol. 2001 Jan;13(1):21-8.
We compared clinical outcomes following percutaneous transluminal coronary angioplasty (PTCA) for 77 chronic renal failure (CRF) (dialysis and nondialysis) patients and a control group matched for history of myocardial revascularization, specific revascularization procedure, gender, age, diabetes, number of native vessels diseased, number of vessels dilated, and the specific vessel(s) dilated. CRF patients had a higher incidence of peripheral vascular disease, hypertension, and more complex PTCA target lesion types than controls: 5% vs. 16% Type A, 12% vs. 28% Type B1, 44% vs. 41% Type B2, 39% vs. 15% Type C (p < 0.001). The primary success rate for PTCA in CRF patients and controls was 89% and 97% (p < 0.05). Survival analysis 24 months following PTCA showed a lower composite cardiac event-free survival (angiographic restenosis, myocardial infarction, coronary artery bypass surgery, and cardiac death) for those with CRF than controls, 54% vs. 69% (p = 0.002). Over the study period, 26 CRF patients died (11 from cardiac causes) compared to only 3 control patients (one from a cardiac cause); p < 0.001 for all cause and p < 0.003 for cardiac mortality. We also compared PTCA results between two categories of CRF patients. The first consisted of 49 end-stage renal disease (ESRD) patients on dialysis and the second included 28 patients not on dialysis (13 with creatinine > 2. 0 mg/dL and 15 with ESRD post-renal transplant). Both subgroups had similar coronary anatomy, including PTCA, target lesion type, and acute and long-term outcomes. In conclusion, we observed acceptable primary success and complication rates for PTCA in CRF patients compared with controls matched for comorbid features despite more complex target lesion morphology. Poorer long-term outcomes, however, were apparent for those with CRF regardless of dialysis dependence and likely relate to more extensive atherosclerosis and complex target coronary lesions at index PTCA as well as other features related to CRF.
我们比较了77例慢性肾衰竭（CRF）（透析和非透析）患者经皮腔内冠状动脉成形术（PTCA）后的临床结果，以及与心肌血运重建史、特定血运重建程序、性别、年龄、糖尿病、病变的自身血管数量、扩张的血管数量和特定扩张血管相匹配的对照组。CRF患者外周血管疾病、高血压的发生率更高，PTCA靶病变类型比对照组更复杂：A型分别为5%和16%，B1型分别为12%和28%，B2型分别为44%和41%，C型分别为39%和15%（p<0.001）。CRF患者和对照组PTCA的主要成功率分别为89%和97%（p<0.05）。PTCA后24个月的生存分析显示，CRF患者的复合无心脏事件生存率（血管造影再狭窄、心肌梗死、冠状动脉搭桥手术和心源性死亡）低于对照组，分别为54%和69%（p = 0.002）。在研究期间，26例CRF患者死亡（11例死于心脏原因），而对照组仅3例患者死亡（1例死于心脏原因）；全因死亡率p<0.001，心源性死亡率p<0.003。我们还比较了两类CRF患者的PTCA结果。第一组包括49例接受透析的终末期肾病（ESRD）患者，第二组包括28例未接受透析的患者（13例肌酐>2.0mg/dL，15例肾移植后ESRD）。两个亚组的冠状动脉解剖结构相似，包括PTCA、靶病变类型以及急性和长期结果。总之，尽管靶病变形态更复杂，但与具有合并症特征相匹配的对照组相比，我们观察到CRF患者PTCA的主要成功率和并发症发生率是可接受的。然而，无论是否依赖透析，CRF患者的长期结果较差，这可能与首次PTCA时更广泛的动脉粥样硬化和复杂的冠状动脉病变以及与CRF相关的其他特征有关。
