Department of Emergency Medicine, Karolinska University Hospital and Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
Int J Cardiol. 2013 Sep 30;168(2):1137-42. doi: 10.1016/j.ijcard.2012.11.082. Epub 2012 Dec 4.
Renal dysfunction is associated with increased long-term mortality and incidence of myocardial infarction following coronary artery bypass grafting (CABG). Little is known about the relationship between renal dysfunction and long-term risk of stroke following CABG.
All 29 057 patients who underwent primary isolated CABG from 2000 through 2008 in Sweden, with no myocardial infarction within 14 days before surgery and no prior stroke, were included from the SWEDEHEART registry. During a mean follow-up of 4.5 years, there were 1563 (5.4%) first strokes (74% ischemic, 8% hemorrhagic, and 18% unspecified). Glomerular filtration rates (eGFR) were estimated using the Modification of Diet in Renal Disease equation. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated for stroke in relation to eGFR. Adjusted HR for all stroke in patients with eGFR 45 to 60, 30 to 45 and 15 to 30 mL/min/1.73 m(2) were; 1.17 (1.03 to 1.34), 1.52 (1.25 to 1.85) and 1.79 (1.20 to 2.65), respectively compared to patients with eGFR >60 mL/min/1.73 m(2). Gender-specific analysis did not show any major differences between men and women. The adjusted risk of hemorrhagic stroke was somewhat higher than for ischemic stroke: HR 2.07 (1.15 to 3.73) vs. 1.55 (1.26 to 1.91), in patients with eGFR 15 to 45 mL/min/1.73 m(2).
Renal dysfunction is associated with increased long-term risk of stroke after primary isolated CABG. The impact of renal dysfunction on risk of stroke appears to be similar for both men and women.
肾功能障碍与冠状动脉旁路移植术（CABG）后长期死亡率和心肌梗死发生率增加有关。对于肾功能障碍与 CABG 后长期中风风险之间的关系知之甚少。
所有 29057 例于 2000 年至 2008 年在瑞典接受单纯 CABG 的患者均来自 SWEDEHEART 注册中心，这些患者在手术前 14 天内无心肌梗死且无既往中风。在平均 4.5 年的随访期间，有 1563 例（5.4%）首次中风（74%为缺血性，8%为出血性，18%为未指明类型）。肾小球滤过率（eGFR）使用肾脏病饮食改良公式（Modification of Diet in Renal Disease equation）估算。计算了 eGFR 与中风之间的风险比（HR）和 95%置信区间（CI）。将 eGFR 为 45 至 60、30 至 45 和 15 至 30 mL/min/1.73 m²的患者的所有中风调整后的 HR 分别为 1.17（1.03 至 1.34）、1.52（1.25 至 1.85）和 1.79（1.20 至 2.65），与 eGFR>60 mL/min/1.73 m²的患者相比。性别特异性分析并未显示男性和女性之间存在任何重大差异。调整后的出血性中风风险略高于缺血性中风：eGFR 为 15 至 45 mL/min/1.73 m²的患者 HR 为 2.07（1.15 至 3.73），1.55（1.26 至 1.91）。
肾功能障碍与原发性单纯 CABG 后长期中风风险增加有关。肾功能障碍对中风风险的影响对于男性和女性似乎相似。
