Iakovou Ioannis, Dangas George, Mehran Roxana, Lansky Alexandra J, Ashby Dale T, Fahy Martin, Mintz Gary S, Kent Kenneth M, Pichard Augusto D, Satler Lowell F, Stone Gregg W, Leon Martin B
Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY, 10022, USA.
J Invasive Cardiol. 2003 Jan;15(1):18-22.
Contrast-induced nephropathy (CIN) is a recognized complication after percutaneous interventions (PCI). We sought to determine the impact of gender on incidence and clinical outcome of CIN.
Of a total 8,628 patients who underwent PCI, there were 1,431 (16.5%) who developed CIN (defined as > 25% rise in creatinine after PCI). Patients were followed clinically for one year. CIN was present in 23.6% of female versus 17.4% of male patients (p < 0.0001). Multivariate analysis showed that female gender (OR = 1.4, 95% CI = 1.25 1.60; p < 0.0001), pre-PCI chronic renal failure (CRF) (OR= 1.8, 95% CI = 1.53 2.10, p < 0.0001), diabetes mellitus (OR = 1.5, 95% CI = 1.34 1.70; p < 0.0001), age (OR = 1.01, 95% CI = 1.01 1.02, p < 0.0001), and hypertension (OR = 1.2, 95% CI = 1.06 1.36, p = 0.0035) were independent predictors of CIN. Clinical outcomes after CIN were examined in patients with or without CRF. Among patients without CRF who developed CIN, females (n = 465) had higher rates of one-year mortality, and MACE comparing to males (n = 710) without CRF (14% vs. 10% mortality, 36% vs. 30% MACE; p = 0.05 and 0.06, respectively). In patients with CRF who developed CIN, we found no significant gender differences in one-year clinical events (37% vs. 36% mortality, 42% vs. 45% MACE; p = 0.8 and 0.6, respectively). By multivariate analysis only baseline CRF, diabetes, age, functional NYHA IV class were identified as independent predictors of one-year mortality in patients with CIN after PCI.
Female gender is an independent predictor of CIN development after PCI and a marker of worse 1-year mortality after CIN in patients without baseline CRF. After CIN is developed, pre-PCI CRF, diabetes mellitus, age, severe heart failure (not gender) are independent predictors of one-year mortality.
造影剂肾病（CIN）是经皮介入治疗（PCI）后一种公认的并发症。我们试图确定性别对CIN发病率和临床结局的影响。
在总共8628例行PCI的患者中，有1431例（16.5%）发生了CIN（定义为PCI后肌酐升高>25%）。对患者进行了为期一年的临床随访。女性患者中CIN的发生率为23.6%，男性患者为17.4%（p<0.0001）。多因素分析显示，女性（OR = 1.4，95%CI = 1.25 - 1.60；p<0.0001）、PCI术前慢性肾衰竭（CRF）（OR = 1.8，95%CI = 1.53 - 2.10，p<0.0001）、糖尿病（OR = 1.5，95%CI = 1.34 - 1.70；p<0.0001）、年龄（OR = 1.01，95%CI = 1.01 - 1.02，p<0.0001）和高血压（OR = 1.2，95%CI = 1.06 - 1.36，p = 0.0035）是CIN的独立预测因素。对发生CIN的患者有无CRF的临床结局进行了检查。在发生CIN且无CRF的患者中，女性（n = 465）的一年死亡率和主要不良心血管事件（MACE）发生率高于无CRF的男性（n = 710）（死亡率分别为14% vs. 10%，MACE分别为36% vs. 30%；p分别为0.05和0.06）。在发生CIN且有CRF的患者中，我们发现一年临床事件的性别差异无统计学意义（死亡率分别为37% vs. 36%，MACE分别为42% vs. 45%；p分别为0.8和0.6）。通过多因素分析，仅基线CRF、糖尿病、年龄、纽约心脏协会（NYHA）功能IV级被确定为PCI后发生CIN患者一年死亡率的独立预测因素。
女性是PCI后CIN发生的独立预测因素，也是无基线CRF患者发生CIN后一年死亡率更差的标志物。发生CIN后，PCI术前CRF、糖尿病、年龄、重度心力衰竭（而非性别）是一年死亡率的独立预测因素。
