早期侵入性治疗对不稳定型冠状动脉疾病合并肾功能不全的患者有益。

Early invasive treatment benefits patients with renal dysfunction in unstable coronary artery disease.

作者信息

Johnston Nina, Jernberg Tomas, Lagerqvist Bo, Wallentin Lars

机构信息

Department of Medical Sciences, Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden.

出版信息

Am Heart J. 2006 Dec;152(6):1052-8. doi: 10.1016/j.ahj.2006.07.014.

DOI:10.1016/j.ahj.2006.07.014

PMID:17161052

Abstract

BACKGROUND

Few studies have investigated the effects of an early revascularization in relation to renal function in patients with unstable coronary artery disease (CAD).

METHODS

Patients (n = 2457) with unstable CAD randomized to a noninvasive or invasive treatment strategy in the Fast Revascularisation during InStability in Coronary artery disease (FRISC-II) trial were stratified according to tertiles of creatinine clearance (CrCl < 69 mL/min, CrCl 69-90 mL/min, CrCl > 90 mL/min) and followed for 2 years regarding death and/or myocardial infarction (MI).

RESULTS

In the noninvasive cohort, the rate of death or MI at 2 years was 22.4% at CrCl < 69 mL/min, 14.6% at CrCl 60-90 mL/min, and 11.6% at CrCl > 90 mL/min. In the invasive cohort, the rate of death or MI was reduced to 14.6% (P = .003) at CrCl < 69 mL/min and to 9.9% (P = .048) at CrCl 69 to 90 mL/min, but no significant reduction (11.2%) at CrCl > 90 mL/min. In a logistic regression analysis adjusting for other important covariables, CrCl < 69 mL/min remained independently associated with the risk of the combined end point in the noninvasively treated group (odds ratio, 1.96; 95% confidence interval, 1.12-3.42) but not in the invasively treated group (odds ratio, 1.09; 95% confidence interval, 0.56-2.14). When the interaction term for treatment strategy and CrCl group was included in the analysis, the interaction between treatment strategy and CrCl <90 mL/min was independently associated with the risk of future MI (P = .006).

CONCLUSION

In unstable CAD, an early invasive treatment strategy reduces the long-term risk of future death and MI in patients with mildly to moderately reduced CrCl.

摘要

背景

很少有研究调查早期血运重建对不稳定型冠状动脉疾病（CAD）患者肾功能的影响。

方法

在冠状动脉疾病不稳定期快速血运重建（FRISC-II）试验中，将2457例不稳定型CAD患者随机分为无创或有创治疗策略组，根据肌酐清除率（CrCl）三分位数分层（CrCl<69 mL/分钟、CrCl 69 - 90 mL/分钟、CrCl>90 mL/分钟），并随访2年观察死亡和/或心肌梗死（MI）情况。

结果

在无创治疗组中，2年时CrCl<69 mL/分钟的患者死亡或MI发生率为22.4%，CrCl 60 - 90 mL/分钟的患者为14.6%，CrCl>90 mL/分钟的患者为11.6%。在有创治疗组中，CrCl<69 mL/分钟时死亡或MI发生率降至14.6%（P = 0.003），CrCl 69至90 mL/分钟时降至9.9%（P = 0.048），但CrCl>90 mL/分钟时无显著降低（11.2%）。在对其他重要协变量进行校正的逻辑回归分析中，CrCl<69 mL/分钟在无创治疗组中仍独立与联合终点风险相关（比值比，1.96；95%置信区间，1.12 - 3.42），但在有创治疗组中并非如此（比值比，1.09；95%置信区间，0.56 - 2.14）。当分析中纳入治疗策略和CrCl分组的交互项时，治疗策略与CrCl<90 mL/分钟之间的交互作用独立与未来MI风险相关（P = 0.006）。