Ota Tomoyuki, Umeda Hisashi, Yokota Shigeki, Miyata Shinjiro, Takamura Atsushi, Sugino Shigeo, Hayashi Kazutaka, Ishiki Ryoji, Takeichi Yasushi, Iwase Mitsunori, Inagaki Haruo, Murohara Toyoaki
Division of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Japan.
Am Heart J. 2009 Jul;158(1):92-8. doi: 10.1016/j.ahj.2009.04.013.
The presence of chronic kidney disease (CKD) is associated with an increased risk of restenosis and major adverse cardiac events (MACEs) after coronary interventions, especially in patients on hemodialysis (HD). The aim of this study was to assess the impact of varying degrees of renal impairment on angiographic and 2-year clinical outcomes after treatment with sirolimus-eluting stents (SESs).
A total of 675 lesions of 593 patients treated with SES were analyzed. Patients were classified into 3 groups: 34 patients on HD; 337 patients with estimated glomerular filtration rate > or =60 mL min(-1) 1.73 m(-2) (non-CKD group); and 222 patients who had lower estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2) without HD dependency (CKD group).
At angiographic follow-up (201 +/- 73 days), in-segment late loss was markedly higher in the HD group versus the non-CKD and CKD groups (0.68 +/- 1.06 vs 0.11 +/- 0.45 and 0.15 +/- 0.50 mm, respectively, P < .001), resulting in a significantly higher in-segment restenosis rate (40.0% vs 10.4% and 11.5%, respectively, P < .001). At 2 years, HD vs non-CKD and CKD was associated with a significantly higher MACE rate (35.3% vs 10.4% and 12.6%, respectively, P < .001), mainly driven by significantly higher mortality (11.8% vs 0.6% and 2.3%, respectively, P < .001) and target-lesion revascularization (23.5% vs 9.2% and 8.1%, respectively, P = .016) rates. Multivariable analysis revealed that HD was the independent predictor of 2-year MACE (hazard ratio 4.70, 95% CI 2.40-9.20, P < .001).
Although angiographic and clinical outcomes after SES implantation were similarly favorable in non-HD-dependent CKD patients, regardless of renal function, in patients with end-stage CKD requiring HD, frequencies of restenosis and 2-year MACE were markedly higher than in non-HD-dependent patients.
慢性肾脏病（CKD）的存在与冠状动脉介入治疗后再狭窄和主要不良心脏事件（MACE）风险增加相关，尤其是在接受血液透析（HD）的患者中。本研究旨在评估不同程度的肾功能损害对西罗莫司洗脱支架（SES）治疗后血管造影和2年临床结局的影响。
对593例接受SES治疗的患者的675处病变进行分析。患者分为3组：34例接受HD治疗的患者；337例估计肾小球滤过率≥60 mL·min⁻¹·1.73 m⁻²的患者（非CKD组）；222例估计肾小球滤过率<60 mL·min⁻¹·1.73 m⁻²且不依赖HD的患者（CKD组）。
在血管造影随访（201±73天）时，HD组节段内晚期管腔丢失明显高于非CKD组和CKD组（分别为0.68±1.06 vs 0.11±0.45和0.15±0.50 mm，P<.001），导致节段内再狭窄率显著更高（分别为40.0% vs 10.4%和11.5%，P<.001）。在2年时，HD组与非CKD组和CKD组相比，MACE发生率显著更高（分别为35.3% vs 10.4%和12.6%，P<.001），主要是由于死亡率显著更高（分别为11.8% vs 0.6%和2.3%，P<.001）和靶病变血运重建率显著更高（分别为23.5% vs 9.2%和8.1%，P=.016）。多变量分析显示，HD是2年MACE的独立预测因素（风险比4.70，95%CI 2.40-9.20，P<.001）。
尽管在不依赖HD的CKD患者中，无论肾功能如何，SES植入后的血管造影和临床结局同样良好，但在需要HD的终末期CKD患者中，再狭窄和2年MACE的发生率明显高于不依赖HD的患者。
