Department of Cardiology, Thoraxcentre, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Neth Heart J. 2007;15(4):133-41. doi: 10.1007/BF03085969.
The use of invasive procedures has mostly been studied in retrospective (multi)- national registries. Limited evidence exists on the association between microalbuminuria and coronary artery disease (CAD).
The incidence of major adverse cardiac events (MACE) and invasive cardiac procedures was registered between 1997 and 2003 in 8139 subjects, without prior documented CAD, in the PREVEND cohort study (the Netherlands), in which the focus is on microalbuminuria and cardiovascular risk. Qualitative coronary angiographic analysis was performed.
During 5.5 years of follow-up, a first MACE occurred in 271 (3.3%) and a first coronary angiography (CAG) was performed in 264 (3.2%) subjects. Of these, 216 CAGs were available for qualitative angiographic analysis. Indications for CAG were stable angina in 129, acute coronary syndrome (ACS) in 55 and ST-elevation myocardial infarction (STEMI) in 32 subjects. Obstructive coronary artery disease was present in 61, 53 and 30 subjects, respectively. A revascularisation was performed in 50 (39%), 50 (91%) and 25 (78%) subjects, respectively. Microalbuminuria was associated with a first MACE, after adjustment for established risk factors. Microalbuminuria was present at baseline in 9% of subjects with normal coronary arteries, in 21% of subjects with one- and two-vessel CAD and in 39% of subjects with threevessel or left main CAD at CAG during follow-up (Ptrend=0.005).
This large cohort study shows that two-thirds of diagnostic CAGs for stable angina were not followed by a revascularisation, in contrast to CAGs for STEMI or ACS. Furthermore, this study shows that microalbuminuria is associated with CAD. (Neth Heart J 2007;15:133-41.).
侵袭性操作的使用主要在回顾性（多）国家登记处进行研究。关于微量白蛋白尿与冠状动脉疾病（CAD）之间的关联，证据有限。
在 PREVEND 队列研究（荷兰）中，在 1997 年至 2003 年期间，在 8139 名无先前记录 CAD 的受试者中登记了主要不良心脏事件（MACE）和侵袭性心脏操作的发生率。进行了定性冠状动脉造影分析。
在 5.5 年的随访期间，271 名（3.3%）受试者发生了首次 MACE，264 名（3.2%）受试者进行了首次冠状动脉造影（CAG）。其中，216 例 CAG 可用于定性血管造影分析。CAG 的指征为 129 例稳定型心绞痛，55 例急性冠状动脉综合征（ACS）和 32 例 ST 段抬高型心肌梗死（STEMI）。分别有 61、53 和 30 名患者存在阻塞性冠状动脉疾病。分别对 50（39%）、50（91%）和 25（78%）名患者进行了血运重建。调整了既定危险因素后，微量白蛋白尿与首次 MACE 相关。在基线时，9%的正常冠状动脉患者、21%的单支和双支 CAD 患者和 39%的三支或左主干 CAD 患者存在微量白蛋白尿（CAG 随访期间，Ptrend=0.005）。
这项大型队列研究表明，稳定型心绞痛的诊断性 CAG 中有三分之二没有进行血运重建，而 STEMI 或 ACS 的 CAG 则不是这样。此外，本研究表明微量白蛋白尿与 CAD 相关。（荷兰心脏杂志 2007；15:133-41.）。
