Division of Cardiovascular Medicine, Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, USA.
Eur J Heart Fail. 2014 Mar;16(3):289-99. doi: 10.1002/ejhf.11. Epub 2013 Dec 6.
Renal dysfunction is associated with poor cardiovascular outcome. We investigated the relationship of kidney function and long-term cardiovascular outcomes in patients with high risk myocardial infarction.
We studied 27 610 patients from four randomized trials of acute myocardial infarction complicated by heart failure and/or LV dysfunction (LVEF ≤40%). Two trials excluded patients with serum creatinine ≥2.5 mg/dL. Patients were grouped by estimated glomerular filtration rate (eGFR) using the four-component Modification of Diet in Renal Disease equation. We used adjusted Cox proportional hazard models to compare mortality and composite cardiovascular events among eGFR groups. Median follow-up was 23 months. The eGFR was approximately normally distributed, with a mean ± SD of 69.1 ± 20.2 mL/min/1.73 m(2) . Co-morbidities were more prevalent with lower eGFR. The risk of death or composite outcome of cardiovascular death, myocardial infarction, stroke, or heart failure hospitalization increased with declining eGFR. Below 75 mL/min/1.73 m(2) , each 10 unit reduction of eGFR was associated with an adjusted hazard ratio for death of 1.13 (95% confidence interval, 1.11-1.15) and composite cardiovascular outcome of 1.09 (95% confidence interval, 1.08-1.10). Older patients (≥75 years) with low LVEF (<30%) had a higher incidence of mortality and adverse cardiovascular events across eGFR categories.
Reduced eGFR is strongly and independently associated with poor cardiovascular outcome following high risk myocardial infarction. In these patients, the combination of older age and poor LV systolic function is associated with increased risk of adverse events.
肾功能障碍与心血管不良预后相关。我们研究了肾功能与高危心肌梗死患者长期心血管结局的关系。
我们研究了四项心力衰竭和/或左心室功能障碍（LVEF≤40%）合并急性心肌梗死的随机临床试验中的 27610 例患者。其中两项试验排除了血清肌酐≥2.5mg/dL 的患者。采用四组分肾脏病饮食改良公式估计肾小球滤过率（eGFR），将患者分为 eGFR 组。我们使用调整后的 Cox 比例风险模型比较 eGFR 组之间的死亡率和复合心血管事件。中位随访时间为 23 个月。eGFR 呈近似正态分布，平均（±标准差）为 69.1±20.2mL/min/1.73m²。共病的发病率随 eGFR 的降低而增加。eGFR 低于 75mL/min/1.73m²时，每降低 10 单位 eGFR，死亡或心血管死亡、心肌梗死、卒中和心力衰竭住院的复合结局风险调整后的风险比分别为 1.13（95%置信区间，1.11-1.15）和 1.09（95%置信区间，1.08-1.10）。年龄较大（≥75 岁）且 LVEF 较低（<30%）的患者，无论 eGFR 水平如何，死亡率和不良心血管事件的发生率均较高。
高危心肌梗死后 eGFR 降低与心血管不良结局密切相关。在这些患者中，年龄较大和左心室收缩功能不良的组合与不良事件风险增加相关。
