van de Wal Ruud M A, van Brussel Ben L, Voors Adriaan A, Smilde Tom D J, Kelder Johannes C, van Swieten Henry A, van Gilst Wiek H, van Veldhuisen Dirk Jan, Plokker H W Thijs
Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
J Thorac Cardiovasc Surg. 2005 Feb;129(2):330-5. doi: 10.1016/j.jtcvs.2004.06.038.
Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of preoperative (mild) renal dysfunction as a long-term predictor of clinical outcome after coronary bypass surgery.
In 358 patients who underwent isolated saphenous vein aorta-coronary artery bypass grafting, estimated glomerular filtration rates were calculated with the Cockroft-Gault equation (GFRc). Patients were categorized into 2 groups (group 1, GFRc >71.1 mL x min (-1) x 1.73 m (-2) ; group 2, GFRc <71.1 mL x min (-1) x 1.73 m (-2) ). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic value of GFRc.
During a median follow-up of 18.2 years, 233 patients (65.1%) died. Patients who died had lower GFRc and were older. Multivariate analysis demonstrated that total mortality in patients with lower GFRc was significantly increased (lower GFRc group vs normal GFRc group: hazard ratio, 1.44; P = .019). Lower GFRc was also an independent predictor of cardiac mortality (hazard ratio, 1.51; P = .032). No significant differences were observed between groups in the occurrence of myocardial infarction and the need for reintervention.
Our study demonstrates that after long-term follow-up, preoperative mild renal dysfunction is an independent predictor of long-term (cardiac) mortality in patients who undergo coronary artery bypass grafting.
肾功能不全是心血管疾病患者的预后指标。然而，尚无关于轻度肾功能不全对冠状动脉搭桥术患者死亡率影响的长期随访研究报道。因此，我们旨在确定术前（轻度）肾功能不全作为冠状动脉搭桥术后临床结局长期预测指标的意义。
在358例行单纯大隐静脉主动脉-冠状动脉搭桥术的患者中，采用Cockcroft-Gault公式计算估算肾小球滤过率（GFRc）。患者被分为两组（1组，GFRc>71.1 mL·min⁻¹·1.73 m⁻²；2组，GFRc<71.1 mL·min⁻¹·1.73 m⁻²）。进行多因素Cox比例风险分析以确定GFRc的独立预后价值。
在中位随访18.2年期间，233例患者（65.1%）死亡。死亡患者的GFRc较低且年龄较大。多因素分析表明，GFRc较低患者的总死亡率显著增加（低GFRc组与正常GFRc组：风险比，1.44；P = 0.019）。较低的GFRc也是心脏死亡的独立预测因素（风险比，1.51；P = 0.032）。两组在心肌梗死发生率和再次干预需求方面未观察到显著差异。
我们的研究表明，经过长期随访，术前轻度肾功能不全是冠状动脉搭桥术患者长期（心脏）死亡率的独立预测因素。
