血小板糖蛋白 IIb/IIIa 受体抑制剂对行直接或补救性经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者肾功能的影响。

Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on renal function in patients with ST-segment elevation myocardial infarction treated with primary or rescue percutaneous coronary intervention.

机构信息

Rambam Health Care Campus Cardiology Department, Haifa, Israel.

出版信息

EuroIntervention. 2009 Nov;5(5):604-9. doi: 10.4244/eijv5i5a97.

DOI:10.4244/eijv5i5a97

PMID:20142182

Abstract

AIMS

Worsening renal function in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. We hypothesised that platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) may decrease the rate of renal function deterioration in these patients through attenuation of platelet aggregation and the possible improvement of renal rheology and haemodynamics.

METHODS AND RESULTS

Based on prospectively collected data, we analysed rates of renal function deterioration in 603 consecutive patients (mean age 58+/-13 years, males 82%) with STEMI treated with primary or rescue PCI. Renal function deterioration was defined as an increase in serum creatinine level of >or=25% and/or >or=0.5 mg/dl at any time point post-PCI during index hospitalisation compared with baseline value. Outcomes were stratified by treatment with GPI. Patients treated with GPI (n=442) vs. patients who were not treated with GPI (n=161) had significantly lower rates of serum creatinine increase of >or=25% compared with baseline (22.9% vs. 31.9%, P=0.02, respectively), of serum creatinine increase >or=0.5 g/dL (4.1% vs. 8.8%, P=0.02). Treatment with GPI was associated with significantly lower mean maximal increase in serum creatinine level compared with baseline value (0.14+/-0.38 vs. 0.25+/-0.45 mg/dL, P=0.005). Rates of major bleeding did not differ significantly between the two groups (7.3% vs. 5.9%; P=0.42), while 30-day mortality was significantly lower in patients treated with GPI (2.3% vs. 7.5%; P=0.005). By multivariable analysis, treatment with GPI was an independent predictor of freedom from renal function deterioration (odds ratio 0.53; 95% confidence interval 0.33-0.86; P=0.01).

CONCLUSIONS

In this analysis, administration of GPI to patients with STEMI treated with primary PCI was associated with lower rates of worsening renal function and lower 30-day mortality.

摘要

目的

经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）患者的肾功能恶化与不良临床结局相关。我们假设血小板糖蛋白 IIb/IIIa 受体抑制剂（GPI）可通过抑制血小板聚集，改善肾脏血流动力学和流变学，从而降低此类患者肾功能恶化的发生率。

方法和结果

我们基于前瞻性收集的数据，分析了 603 例连续 STEMI 患者（平均年龄 58+/-13 岁，男性占 82%）行直接或补救性 PCI 后的肾功能恶化发生率。肾功能恶化定义为 PCI 后住院期间任何时间点的血清肌酐水平较基线升高 >or=25%和/或 >or=0.5mg/dl。根据是否使用 GPI 进行分层。与未使用 GPI 的患者（n=161）相比，使用 GPI 的患者（n=442）的血清肌酐较基线升高 >or=25%的发生率显著更低（分别为 22.9% vs. 31.9%，P=0.02），血清肌酐升高 >or=0.5mg/dl 的发生率也显著更低（分别为 4.1% vs. 8.8%，P=0.02）。与未使用 GPI 的患者相比，使用 GPI 的患者的血清肌酐最高水平较基线值的平均增加值显著更低（0.14+/-0.38 vs. 0.25+/-0.45mg/dl，P=0.005）。两组的主要出血发生率无显著差异（分别为 7.3% vs. 5.9%，P=0.42），但使用 GPI 的患者的 30 天死亡率显著更低（分别为 2.3% vs. 7.5%，P=0.005）。多变量分析显示，使用 GPI 是肾功能恶化的独立预测因子（比值比 0.53；95%置信区间 0.33-0.86；P=0.01）。