Shaw James A, Andrianopoulos Nick, Duffy Stephen, Walton Anthony S, Clark David, Lew Robert, Sebastian Martin, New Gishel, Brennan Angela, Reid Chris, Ajani Andrew E
Department of Cardiology of The Alfred Hospital, Melbourne, Australia.
Cardiovasc Revasc Med. 2008 Oct-Dec;9(4):218-23. doi: 10.1016/j.carrev.2008.05.002.
Renal impairment (RI) is known to be an independent risk factor for the progression of cardiovascular disease. Its impact, however, on the outcomes in patients undergoing percutaneous coronary intervention (PCI) especially in the era of drug-eluting stents (DES) is not well known. We analysed data from patients undergoing PCI from April 1, 2004, to September 30, 2006, who were part of the Melbourne Interventional Group registry. RI was defined as an estimated glomerular filtration rate (eGFR), calculated using Cockcroft-Gault formula, of <60 ml/min. We compared outcomes at 30 days and 12 months in patients with and without RI. Four thousand one hundred ninety-five patients (3043 male) with an average age 65+/-12 years (mean+/-S.D.) underwent PCI. Twelve-month follow-up was available in 3963 (95%) patients, and these were included in the analysis. One thousand twelve patients (26%) had RI; of these, 608 (60%) presented with an acute coronary syndrome. Both 30-day major adverse cardiac events (MACE), 9.1% vs. 4.6% (P<.01), and all-cause mortality, 4.5% vs. 0.7% (P<.01), were significantly higher in those with RI compared to those without RI. Twelve-month mortality (8.8% vs. 1.7%, P<.01) and MACE (19.7% vs. 10.3%, P<.01) were also significantly higher in those with RI. In multiple regression analysis, RI was an independent predictor of 12-month MACE [OR 2.0 (CI 1.6-2.6), P<.01]. RI is an independent predictor of 30-day and 12-month MACE and death after PCI in patients with stable and unstable coronary syndromes, even with widespread use of DES. eGFR should be used to help risk-stratify patients undergoing PCI.
肾功能损害（RI）是已知的心血管疾病进展的独立危险因素。然而，其对接受经皮冠状动脉介入治疗（PCI）患者结局的影响，尤其是在药物洗脱支架（DES）时代，尚不为人所知。我们分析了2004年4月1日至2006年9月30日期间接受PCI的患者数据，这些患者是墨尔本介入治疗组登记处的一部分。RI定义为使用Cockcroft-Gault公式计算的估计肾小球滤过率（eGFR）<60 ml/分钟。我们比较了有和没有RI的患者在30天和12个月时的结局。4195例患者（3043例男性）平均年龄65±12岁（均值±标准差）接受了PCI。3963例（95%）患者有12个月的随访，这些患者被纳入分析。1012例患者（26%）有RI；其中，608例（60%）表现为急性冠状动脉综合征。有RI的患者30天主要不良心脏事件（MACE）发生率为9.1%，无RI的患者为4.6%（P<0.01），全因死亡率分别为4.5%和0.7%（P<0.01），均显著高于无RI的患者。有RI的患者12个月死亡率（8.8%对1.7%，P<0.01）和MACE（19.7%对10.3%，P<0.01）也显著更高。在多因素回归分析中，RI是12个月MACE的独立预测因素[比值比2.0（可信区间1.6 - 2.6），P<0.01]。即使广泛使用DES，RI仍是稳定和不稳定冠状动脉综合征患者PCI后30天和12个月MACE及死亡的独立预测因素。应使用eGFR来帮助对接受PCI的患者进行风险分层。
