Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, Louisiana 70112, USA.
JACC Cardiovasc Interv. 2011 Sep;4(9):1002-8. doi: 10.1016/j.jcin.2011.05.022.
This study sought to evaluate the characteristics, therapies, and outcomes of patients with chronic kidney disease (CKD) presenting with non-ST-segment elevation myocardial infarction (NSTEMI) and managed with percutaneous coronary intervention (PCI). This specific population has not been evaluated previously.
Among patients with acute coronary syndrome, the presence of renal dysfunction is associated with an increased risk of death and major bleeding.
We examined data on 40,074 NSTEMI patients managed with PCI who were captured by the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry. Patients were divided according to baseline renal function in 4 groups: no CKD and CKD stages 3, 4, and 5.
Overall, 31.1% (n = 12,045) of patients with NSTEMI undergoing PCI had CKD. Compared with patients with normal renal function, CKD patients managed with PCI had significantly more history of myocardial infarction, heart failure, and more 3-vessel coronary artery disease. They received fewer antithrombotic therapies but were treated more frequently with bivalirudin. In addition, they had significantly higher rates of in-hospital mortality and major bleeding. CKD stage 4 was associated with the highest risk of adverse events relative to no CKD. The multivariable adjusted odds ratios of in-hospital mortality for CKD stages 3, 4, and 5 relative to no CKD were 2.0, 2.8, and 2.6, respectively (global p value <0.0001), and the analogous adjusted odds ratios of major bleeding were 1.5, 2.8, and 1.8, respectively (global p value <0.0001).
CKD patients presenting with NSTEMI and managed with PCI have more comorbidities and receive guideline-recommended therapies less frequently than do patients without CKD. CKD is strongly associated with in-hospital mortality and bleeding in NSTEMI patients undergoing PCI.
本研究旨在评估患有非 ST 段抬高型心肌梗死（NSTEMI）并接受经皮冠状动脉介入治疗（PCI）的慢性肾脏病（CKD）患者的特征、治疗方法和结局。这一特定人群以前尚未得到评估。
在急性冠状动脉综合征患者中，肾功能不全的存在与死亡和大出血风险增加相关。
我们检查了 ACTION（急性冠状动脉治疗和干预结果网络）注册中心收录的 40074 名接受 PCI 治疗的 NSTEMI 患者的数据。根据基线肾功能将患者分为 4 组：无 CKD 和 CKD 3、4 和 5 期。
总体而言，接受 PCI 治疗的 NSTEMI 患者中 31.1%（n=12045）患有 CKD。与肾功能正常的患者相比，接受 PCI 治疗的 CKD 患者有更多的心肌梗死、心力衰竭病史，且更多为 3 支血管冠状动脉疾病。他们接受的抗血栓治疗较少，但更常使用比伐卢定。此外，他们的院内死亡率和大出血发生率明显更高。与无 CKD 相比，CKD 4 期与不良事件风险最高相关。CKD 3、4 和 5 期与无 CKD 相比，院内死亡率的多变量调整比值比分别为 2.0、2.8 和 2.6（全局 p 值<0.0001），大出血的类似调整比值比分别为 1.5、2.8 和 1.8（全局 p 值<0.0001）。
患有 NSTEMI 并接受 PCI 治疗的 CKD 患者比无 CKD 的患者合并症更多，接受指南推荐的治疗方法的频率也更低。CKD 与接受 PCI 的 NSTEMI 患者的院内死亡率和出血密切相关。
