Division of Cardiology, UCLA Medical Center, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, USA.
Catheter Cardiovasc Interv. 2010 Aug 1;76(2):272-8. doi: 10.1002/ccd.22479.
To evaluate the clinical outcomes in patients with chronic renal insufficiency (CRI) who undergo saphenous vein graft (SVG) intervention with drug-eluting stents (DES).
Patients with CRI have higher rates of major adverse cardiac events (MACE) after percutaneous revascularization. SVG intervention is associated with increased rates of MACE compared with percutaneous revascularization of native arteries. However, the impact of CRI on SVG intervention with DES has not been well delineated.
Consecutive patients who underwent SVG intervention with DES at five medical centers from April 2003 to December 2007 were included in this analysis.
A total of 172 patients, 39 patients with CRI and a serum creatinine > or =1.5 mg dL(-1), and 133 patients without CRI, underwent SVG intervention with DES. Patients with CRI were more often older, diabetic, and had a longer mean total stent length. At 1 year, patients with CRI had a higher MACE rate (35.9% vs. 15.8%, hazard ratio [HR] 2.48, 95% confidence interval [CI] 1.26-4.88, log rank P = 0.009), mainly driven by higher mortality (20.5% vs. 9.8%, HR 3.41, 95% CI 1.10-10.58, log rank P = 0.024). There was a trend toward higher rates of target vessel revascularization in the CRI group (21.8% vs. 10.3%, HR 2.42, 95% CI 0.94-6.24, log rank P = 0.059). Stent thrombosis rates were not different between patients with and without CRI (2.6% vs. 2.3%, P = 0.8). Multivariable analysis revealed that CRI was the only significant predictor of 1-year MACE (HR 2.2, 95% CI 1.1-4.3; P = 0.03).
Patients with CRI who underwent SVG intervention with DES had higher risks of MACE and death compared with patients with preserved renal function. Further treatment strategies are needed in this high-risk group who undergo SVG intervention with DES.
评估慢性肾功能不全（CRI）患者行药物洗脱支架（DES）治疗的隐静脉桥（SVG）干预的临床结局。
经皮血运重建后，CRI 患者发生主要不良心脏事件（MACE）的风险更高。与经皮血运重建治疗原生动脉相比，SVG 干预与更高的 MACE 发生率相关。然而，CRI 对 DES 治疗 SVG 的影响尚未明确。
本分析纳入了 2003 年 4 月至 2007 年 12 月期间在五个医疗中心接受 DES 治疗的 SVG 干预的连续患者。
共纳入 172 例患者，39 例 CRI 患者（血清肌酐 >或=1.5mg/dL（-1））和 133 例非 CRI 患者，均接受了 SVG 干预与 DES。CRI 患者年龄更大、糖尿病更多，平均总支架长度更长。1 年时，CRI 组的 MACE 发生率更高（35.9%比 15.8%，风险比[HR]2.48，95%置信区间[CI]1.26-4.88，对数秩检验 P=0.009），主要归因于死亡率更高（20.5%比 9.8%，HR 3.41，95%CI 1.10-10.58，对数秩检验 P=0.024）。CRI 组的靶血管血运重建率也呈升高趋势（21.8%比 10.3%，HR 2.42，95%CI 0.94-6.24，对数秩检验 P=0.059）。CRI 组和非 CRI 组的支架血栓形成率无差异（2.6%比 2.3%，P=0.8）。多变量分析显示，CRI 是 1 年 MACE 的唯一显著预测因素（HR 2.2，95%CI 1.1-4.3；P=0.03）。
与肾功能正常的患者相比，接受 DES 治疗的 SVG 干预的 CRI 患者发生 MACE 和死亡的风险更高。在接受 DES 治疗 SVG 的高危人群中，需要进一步的治疗策略。
