肾功能不全患者的冠状动脉血运重建：再狭窄率和心血管结局

Coronary revascularization in patients with renal insufficiency: restenosis rate and cardiovascular outcomes.

作者信息

Pinkau Tobias, Mann Johannes F E, Ndrepepa Gjin, Mehilli Julinda, Hadamitzky Martin, Braun Siegmund, Kastrati Adnan, Schömig Albert

机构信息

Deutsches Herzzentrum, Technische Universität, Munich, Germany.

出版信息

Am J Kidney Dis. 2004 Oct;44(4):627-35.

PMID:15384013

Abstract

BACKGROUND

Several interventional trials have shown a lower success rate for coronary angioplasty and lower long-term event-free survival in patients with renal insufficiency, and data are conflicting about restenosis after coronary angioplasty.

METHODS

This study included 4,131 consecutive patients with coronary artery disease treated with coronary angioplasty (23%) or stenting (77%). Renal insufficiency is defined as a creatinine clearance (CrCl) less than 60 mL/min (<1.0 mL/s). Of 4,131 patients, 1,412 patients (34.2%) had renal insufficiency and 2,719 patients (65.8%) did not have renal insufficiency. The primary end point of the study is clinical restenosis, defined as the need for target-lesion revascularization.

RESULTS

There was no difference in clinical restenosis rates between groups after 1 year (18.8% versus 18.4%; P = 0.75). The incidence of angiographic restenosis at the 6-month angiography was 32.7% in the group with renal insufficiency and 29.7% in the group without renal insufficiency ( P = 0.10). The composite end point of death and myocardial infarction was observed more frequently in patients with than without renal insufficiency (8.3% versus 3.2%; P < 0.001). Renal insufficiency was not independently associated with clinical restenosis (for 10-mL/min [0.167-mL/s]) decrease in CrCl, adjusted odds ratio, 1.03; 95% confidence interval [CI], 0.98 to 1.08; P = 0.198), but remained as an independent predictor for death or myocardial infarction (for 10-mL/min [0.167-mL/s] decrease in CrCl, hazard ratio, 1.29; 95% CI, 1.18 to 1.42; P < 0.001).

CONCLUSION

Patients with renal insufficiency do not show an increased incidence of restenosis after coronary revascularization.

摘要

背景

多项介入试验表明，肾功能不全患者冠状动脉血管成形术的成功率较低，长期无事件生存率也较低，且关于冠状动脉血管成形术后再狭窄的数据存在矛盾。

方法

本研究纳入了4131例接受冠状动脉血管成形术（23%）或支架置入术（77%）治疗的连续性冠心病患者。肾功能不全定义为肌酐清除率（CrCl）低于60 mL/分钟（<1.0 mL/秒）。在4131例患者中，1412例患者（34.2%）存在肾功能不全，2719例患者（65.8%）不存在肾功能不全。该研究的主要终点是临床再狭窄，定义为靶病变血运重建的必要性。

结果

1年后两组的临床再狭窄率无差异（18.8%对18.4%；P = 0.75）。肾功能不全组在6个月血管造影时的血管造影再狭窄发生率为32.7%，无肾功能不全组为29.7%（P = 0.10）。与无肾功能不全的患者相比，肾功能不全患者死亡和心肌梗死的复合终点观察更为频繁（8.3%对3.2%；P < 0.001）。肾功能不全与临床再狭窄无独立相关性（CrCl每降低10 mL/分钟[0.167 mL/秒]，调整后的优势比为1.03；95%置信区间[CI]为0.98至1.08；P = 0.198），但仍是死亡或心肌梗死的独立预测因素（CrCl每降低10 mL/分钟[0.167 mL/秒]，风险比为1.29；95% CI为1.18至1.42；P < 0.001）。