Krause Michelle W, Massing Mark, Kshirsagar Abhijit, Rosamond Wayne, Simpson Ross J
Division of Nephrology and Hypertension, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Ren Fail. 2004 Nov;26(6):715-25. doi: 10.1081/jdi-200037110.
Individuals with chronic kidney disease have a high mortality rate after acute myocardial infarction. It is not known how frequently these individuals are prescribed combination cardioprotective therapy and if survival is affected by such therapy after acute myocardial infarction.
A retrospective cohort study of 1,342 Medicare recipients with acute myocardial infarction. Data were collected by medical chart abstraction as part of the Cooperative Cardiovascular Project in 60 hospitals in North Carolina during 5/30/1996-12/28/1997. We categorized cardioprotective medication use as aspirin alone, aspirin with beta-blockers, and aspirin with beta-blockers and ace-inhibitors. Chronic kidney disease was defined as a derived glomerular filtration rate (GFR) ranging from 15-89 mL/min/1.73 m2. Cox proportional hazards regression analyses were performed to determine the effect of cardioprotective medication use on survival while controlling for potential explanatory variables.
The prevalence of cardioprotective medication use differed among levels of chronic kidney disease. Those with severe kidney disease (GFR 15-29 mL/min/1.73 m2) were less frequently prescribed aspirin with beta-blockers, 27.1%, and only 8.6% were prescribed aspirin with beta-blockers and ace-inhibitors. Survival was improved with prescribed cardioprotective medication use. In severe kidney disease (GFR 15-29 mL/min/1.73 m2), the hazards risk for death was 0.21 (0.08, 0.53) for aspirin alone, 0.17 (0.06, 0.51) for aspirin with beta-blockers, and 0.35 (0.09, 1.42) for aspirin with beta-blockers and ace-inhibitors.
Individuals with chronic kidney disease benefit from combination cardioprotective therapy, but are less likely to be prescribed them after acute myocardial infarction. Further investigation is warranted to identify possible reasons for these observed treatment disparities.
慢性肾脏病患者急性心肌梗死后死亡率很高。目前尚不清楚这些患者接受联合心脏保护治疗的频率，以及急性心肌梗死后这种治疗是否会影响生存率。
对1342名接受医疗保险的急性心肌梗死患者进行回顾性队列研究。作为合作心血管项目的一部分，于1996年5月30日至1997年12月28日期间在北卡罗来纳州的60家医院通过病历摘要收集数据。我们将心脏保护药物的使用分为单独使用阿司匹林、阿司匹林联合β受体阻滞剂以及阿司匹林联合β受体阻滞剂和血管紧张素转换酶抑制剂。慢性肾脏病定义为估算的肾小球滤过率（GFR）在15 - 89 mL/min/1.73 m²之间。进行Cox比例风险回归分析以确定心脏保护药物的使用对生存率的影响，同时控制潜在的解释变量。
心脏保护药物使用的患病率在不同程度的慢性肾脏病患者中有所不同。重度肾脏病患者（GFR 15 - 29 mL/min/1.73 m²）接受阿司匹林联合β受体阻滞剂治疗的频率较低，为27.1%，仅有8.6%接受阿司匹林联合β受体阻滞剂和血管紧张素转换酶抑制剂治疗。使用规定的心脏保护药物可提高生存率。在重度肾脏病患者（GFR 15 - 29 mL/min/1.73 m²）中，单独使用阿司匹林的死亡风险比为0.21（0.08，0.53），阿司匹林联合β受体阻滞剂的为0.17（0.06，0.51），阿司匹林联合β受体阻滞剂和血管紧张素转换酶抑制剂的为0.35（0.09，1.42）。
慢性肾脏病患者从联合心脏保护治疗中获益，但急性心肌梗死后接受此类治疗的可能性较小。有必要进一步调查以确定这些观察到的治疗差异的可能原因。
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