急性心肌梗死患者直接经皮冠状动脉介入治疗后，入院时肾小球滤过率对心肌灌注不良发生的影响。

Impact of admission glomerular filtration rate on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction.

作者信息

Celik Turgay, Iyisoy Atila, Yuksel Cagdas U, Kilic Selim, Yilmaz M Ilker, Akgul E Ozgur, Jata Bekim, Isik Ersoy

机构信息

Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey.

出版信息

Coron Artery Dis. 2008 Dec;19(8):543-9. doi: 10.1097/MCA.0b013e3283108fef.

DOI:10.1097/MCA.0b013e3283108fef

PMID:19005288

Abstract

AIMS

We aimed to investigate the impact of admission estimated glomerular filtration rates (eGFR) on the development of poor myocardial perfusion after primary percutaneous coronary intervention (pPCI) in patients presenting with acute ST-segment-elevation myocardial infarction (STEMI).

MATERIALS AND METHODS

Study population consisted of 80 patients with STEMI (64 men, mean age=67.5+/-6.6 years) undergoing pPCI. Myocardial perfusion was evaluated by using thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG). Patients were divided into two groups according to TMPG after pPCI. Group 1 and 2 consisted of 40 patients with TMPGs 0-1 and 40 patients with TMPGs 2-3, respectively. GFR was calculated based on the abbreviated Modification of Diet in Renal Disease study equation.

RESULTS

Admission serum creatine kinase-MB isoenzyme (CKMB) levels and the percentage of lower eGFR (<60 ml/min/1.73 m2) values of the patients with TMPGs 0-1 were significantly higher than those of the patients with TMPGs 2-3 after primary PCI (P=0.007, P<0.001, respectively). Univariate analysis identified pain-to-balloon time, eGFR lower than 60 ml/min/1.73 m2, peak CKMB, and TIMI flow grade 0/1 as the predictors of poor myocardial perfusion. In multivariate analysis peak CKMB, left ventricular ejection fraction less than 35%, admission TIMI flow grade 0/1, lower eGFR and pain-to-balloon time continued to have statistically significant independent association with poor myocardial perfusion in the model. Adjusted odds ratios were calculated as 12.05 for low eGFR [P=0.005; confidence interval (CI): 2.11-68.70], 8.10 for admission TIMI grade 0/1 (P=0.04; CI: 1.37-47.91), 7.04 for pain-to-balloon time (P<0.001; CI: 2.37-20.90), 6.76 for low left ventricular ejection fraction (P=0.03; CI: 1.12-40.61), and 1.02 for CKMB (P=0.01; CI: 1.00-1.04).

CONCLUSION

Decreased GFR on admission in patients with STEMI is independently associated with the risk of poor myocardial perfusion following after primary PCI.

摘要

目的

我们旨在研究急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（pPCI）后，入院时估计肾小球滤过率（eGFR）对心肌灌注不良发生情况的影响。

材料与方法

研究人群包括80例接受pPCI的STEMI患者（64例男性，平均年龄=67.5±6.6岁）。采用心肌梗死溶栓（TIMI）心肌灌注分级（TMPG）评估心肌灌注。根据pPCI后的TMPG将患者分为两组。第1组和第2组分别由40例TMPG为0 - 1级的患者和40例TMPG为2 - 3级的患者组成。基于简化的肾脏疾病饮食改良研究方程计算肾小球滤过率。

结果

直接PCI后，TMPG为0 - 1级患者的入院血清肌酸激酶 - MB同工酶（CKMB）水平以及较低eGFR（<60 ml/min/1.73 m²）值的百分比显著高于TMPG为2 - 3级的患者（分别为P = 0.007，P < 0.001）。单因素分析确定疼痛至球囊扩张时间、eGFR低于60 ml/min/1.73 m²、CKMB峰值以及TIMI血流分级0/1为心肌灌注不良的预测因素。多因素分析中，CKMB峰值、左心室射血分数低于35%、入院时TIMI血流分级0/1、较低的eGFR以及疼痛至球囊扩张时间在模型中继续与心肌灌注不良存在统计学显著的独立关联。低eGFR的调整比值比计算为12.05 [P = 0.005；置信区间（CI）：2.11 - 68.70]，入院时TIMI分级0/1为8.10（P = 0.04；CI：1.37 - 47.91），疼痛至球囊扩张时间为7.04（P < 0.001；CI：2.37 - 20.90），低左心室射血分数为6.76（P = 0.03；CI：1.12 - 40.61），CKMB为1.02（P = 0.01；CI：1.00 - 1.04）。