Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Atherosclerosis. 2013 Jul;229(1):258-62. doi: 10.1016/j.atherosclerosis.2013.04.029. Epub 2013 May 9.
The influence of renal function on outcome in stable outpatients with atherosclerotic disease has not been thoroughly studied.
We used the FRENA Registry data to compare the incidence of subsequent ischemic events (myocardial infarction [MI], ischemic stroke or limb amputation) in patients with coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD), according to their estimated glomerular filtration rate (eGFR) at baseline.
As of April 2012, 3860 patients were recruited in FRENA: 1439 with CAD, 1118 with CVD and 1303 with PAD. Over a mean follow-up of 14 ± 12 months, 97 patients suffered subsequent MI, 93 had ischemic stroke and 46 underwent limb amputation. In all, 2699 patients (70%) had eGFR > 60 mL/min/1.73 m(2), 1022 (26%) had 30-60 mL/min/1.73 m(2), and 139 (3.6%) had <30 mL/min/1.73 m(2). Among patients with CAD, the rate of subsequent MI was: 1.38 (95% CI: 0.85-2.11), 5.79 (95% CI: 3.90-8.31) and 18.8 (95% CI: 9.14-34.4) events per 100 patient-years, respectively. On multivariable analysis, the hazard ratio for MI (compared with patients with eGFR > 60 mL/min/1.73 m(2)) was of 1.77 (95% CI: 1.15-2.73) for patients with eGFR of 30-60 mL/min/1.73 m(2), and 3.15 (95% CI: 1.61-6.14) for those with eGFR < 30 mL/min/1.73 m(2). Among patients with CVD or PAD, there was no increasing rate of subsequent ischemic events with decreasing renal function.
Among stable outpatients with CAD, there is an increasing rate of subsequent MI with decreasing renal function, independently of potentially confounding variables. These findings were not observed in patients with CVD or PAD.
肾功能对稳定性动脉粥样硬化疾病门诊患者预后的影响尚未得到充分研究。
我们利用 FRENA 登记数据，根据基线时的估算肾小球滤过率（eGFR），比较了冠状动脉疾病（CAD）、脑血管疾病（CVD）或外周动脉疾病（PAD）患者随后发生缺血性事件（心肌梗死[MI]、缺血性中风或肢体截肢）的发生率。
截至 2012 年 4 月，FRENA 共招募了 3860 名患者：1439 名 CAD 患者、1118 名 CVD 患者和 1303 名 PAD 患者。平均随访 14±12 个月后，97 名患者发生了后续 MI，93 名发生了缺血性中风，46 名发生了肢体截肢。共有 2699 名患者（70%）的 eGFR＞60 mL/min/1.73 m（2），1022 名患者（26%）的 eGFR 为 30-60 mL/min/1.73 m（2），139 名患者（3.6%）的 eGFR＜30 mL/min/1.73 m（2）。在 CAD 患者中，随后 MI 的发生率分别为：每 100 名患者年 1.38（95%CI：0.85-2.11）、5.79（95%CI：3.90-8.31）和 18.8（95%CI：9.14-34.4）事件。多变量分析显示，与 eGFR＞60 mL/min/1.73 m（2）的患者相比，eGFR 为 30-60 mL/min/1.73 m（2）的患者 MI 的风险比为 1.77（95%CI：1.15-2.73），eGFR＜30 mL/min/1.73 m（2）的患者为 3.15（95%CI：1.61-6.14）。在 CVD 或 PAD 患者中，随着肾功能的降低，没有发生后续缺血性事件的发生率增加。
在稳定性 CAD 门诊患者中，随着肾功能的降低，随后发生 MI 的发生率增加，这与潜在的混杂因素无关。在 CVD 或 PAD 患者中，没有观察到这种情况。
