Sanchez Hidalgo A, Pou M, Leiro R, López Gómez D, Martínez Ruiz Md, Saurina A, Esteve V, Fulquet M, Ramírez de Arellano M, de Miguel Ma
Servicios de Cardiología y Nefrología, Hospital de Terrassa, Terrassa, Spain.
Nefrologia. 2009;29(1):53-60. doi: 10.3265/Nefrologia.2009.29.1.53.1.en.full.pdf.
renal glomerular filtration rate on hospital admission in patients presented with an acute coronary syndrome as a predictor for mortality.
The study analysed 290 patients admitted on hospital with an acute coronary syndrome during one year (2003). Renal function was estimated using the renal glomerular filtration rate by the MDRD formula. Patients were stratified in three groups: patients with a GFR > or = 60 ml/min/1,73 m2; n = 186, patients with GFR < 60 or > 30; n = 93 and patients with GFR < 30; n = 11.
66.6% of patients were males and 66.5% were older than 65 years old. 54.5% suffered from hypertension and 39% were diabetics. All patients with GFR < 30 ml/min had an acute coronary syndrome without elevation of ST segment. They were the oldest with a major proportion of previous cardiovascular events as cerebrovascular disease, peripheral vascular disease or myocardial infarction. Diagnostic procedures and treatments were less administered in patients with GFR < 30 ml/min. Although in the univariate analysis demonstrated that hospital mortality was related to GFR < 30 ml/min, sex, ageing, Killip > 1, ventricular function and cTnT elevation, only GFR < 30 ml/min, ageing, heart failure and ventricular dysfunction persisted significant in the multivariate analysis. Hospital mortality was 27.3% in patients with GFR < 30 ml/min, 7.5% in patients with GFR between 30-60 ml/min and 3.8% in patients with a GFR > or = 60 ml/min. Mortality after two years follow up was 27.3% in patients with GFR < 30 ml/min, 20.4% in patients with GFR between 30-60 ml/min and 10.2% in patients with a GFR > or = 60 ml/min. Mortality (hospital mortality and after two years of follow up) was increased in patients with GFR< 30 ml/min, ageing, heart failure and diabetes after adjusted for other prognostic factors.
A reduced glomerular filtration rate is an independent risk factor for mortality in patients with an acute coronary syndrome. Estimation of the renal glomerular filtration rate might be used as prognostic value in these patients.
急性冠状动脉综合征患者入院时的肾小球滤过率作为死亡率的预测指标。
本研究分析了2003年一年内因急性冠状动脉综合征入院的290例患者。采用MDRD公式通过肾小球滤过率评估肾功能。患者分为三组：肾小球滤过率（GFR）≥60 ml/min/1.73 m²的患者；n = 186，GFR＜60或＞30的患者；n = 93，GFR＜30的患者；n = 11。
66.6%的患者为男性，66.5%的患者年龄超过65岁。54.5%的患者患有高血压，39%的患者患有糖尿病。所有GFR＜30 ml/min的患者均患有无ST段抬高的急性冠状动脉综合征。他们年龄最大，既往有较大比例的心血管事件，如脑血管疾病、外周血管疾病或心肌梗死。GFR＜30 ml/min的患者接受的诊断程序和治疗较少。尽管单因素分析表明医院死亡率与GFR＜30 ml/min、性别、年龄、Killip＞1、心室功能和肌钙蛋白T升高有关，但在多因素分析中，只有GFR＜30 ml/min、年龄、心力衰竭和心室功能障碍仍具有显著意义。GFR＜30 ml/min的患者医院死亡率为27.3%，GFR在30 - 60 ml/min之间的患者为7.5%，GFR≥60 ml/min的患者为3.8%。两年随访后的死亡率，GFR＜30 ml/min的患者为27.3%，GFR在30 - 60 ml/min之间的患者为20.4%，GFR≥60 ml/min的患者为10.2%。在对其他预后因素进行校正后，GFR＜30 ml/min、年龄、心力衰竭和糖尿病患者的死亡率（医院死亡率和两年随访后）有所增加。
肾小球滤过率降低是急性冠状动脉综合征患者死亡率的独立危险因素。肾小球滤过率的评估可作为这些患者的预后指标。
