Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
Int J Cardiol. 2013 Oct 15;168(6):5405-10. doi: 10.1016/j.ijcard.2013.08.049. Epub 2013 Aug 24.
Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke.
50,244 patients who underwent coronary artery bypass grafting (CABG) in Sweden between 2000 and 2008 were identified from the SWEDEHEART registry. After exclusions 23,584 patients without prior stroke who underwent elective, primary, isolated, CABG were included. AKI was categorized according to absolute increases in postoperative creatinine values compared with preoperative values: stage 1, 0.3-0.5 mg/dL (26-44 μmol/L); stage 2, 0.5-1.0mg/dL (44-88 μmol/L); and stage 3, >1.0 mg/dL (≥88 μmol/L). Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. There were 1156 (4.9%) strokes during a mean follow-up of 4.1 years. After adjustment for confounders, HRs (95% CIs) for stroke in AKI stages 1, 2 and 3 were 1.12 (0.89-1.39), 1.31 (1.04-1.66) and 1.31 (0.92-1.87), respectively, compared with no AKI. This association disappeared after taking death into account in competing risk analysis. There was a significant association between AKI and stroke in men (HR: 1.26 [1.05-1.50]) but not in women (HR: 1.07 [0.75-1.53]), and in younger (<65 years; HR: 1.57 [1.12-2.22]), but not elderly patients (HR: 1.17 [0.98-1.40]).
The long-term risk of stroke is weakly associated with AKI after primary isolated CABG, but this association is attenuated and not significant when considering death as a competing risk.
急性肾损伤（AKI）与冠心病患者的死亡、终末期肾病和心力衰竭有关。本研究调查了 AKI 与长期中风风险之间的关系。
从 SWEDEHEART 注册中心确定了 2000 年至 2008 年间在瑞典接受冠状动脉旁路移植术（CABG）的 50244 名患者。排除无既往中风且接受择期、原发性、孤立性 CABG 的 23584 名患者后，纳入 23584 名患者。根据术后肌酐值相对于术前值的绝对值增加，将 AKI 分为以下几个阶段：1 期，0.3-0.5mg/dL（26-44μmol/L）；2 期，0.5-1.0mg/dL（44-88μmol/L）；3 期，>1.0mg/dL（≥88μmol/L）。使用 Cox 比例风险回归计算中风的风险比（HR）及其 95%置信区间（CI）。在平均随访 4.1 年后，发生了 1156 例（4.9%）中风。在校正混杂因素后，AKI 1 期、2 期和 3 期的中风 HR（95%CI）分别为 1.12（0.89-1.39）、1.31（1.04-1.66）和 1.31（0.92-1.87），与无 AKI 相比。在竞争风险分析中考虑死亡后，这种关联消失了。AKI 与男性中风之间存在显著关联（HR：1.26 [1.05-1.50]），但与女性中风之间没有关联（HR：1.07 [0.75-1.53]），与年轻（<65 岁；HR：1.57 [1.12-2.22]）但与老年患者（HR：1.17 [0.98-1.40]）之间没有关联。
原发性孤立性 CABG 后，AKI 与长期中风风险呈弱相关，但考虑到死亡作为竞争风险时，这种关联减弱且无统计学意义。
