Department of Surgery, Robert C Byrd Health Sciences Center, West Virginia University, Charleston, WV.
Department of Surgery, Robert C Byrd Health Sciences Center, West Virginia University, Charleston, WV.
J Am Coll Surg. 2014 Apr;218(4):797-805. doi: 10.1016/j.jamcollsurg.2013.12.038. Epub 2014 Jan 10.
This study analyzed the impact of chronic renal insufficiency (CRI) on early and late clinical outcomes of carotid artery stenting (CAS) using serum creatinine and glomerular filtration rate (GFR).
There were 313 CAS patients classified into 3 groups: normal (serum creatinine <1.5 mg/dL or GFR ≥ 60 mL/min/1.73 m(2)); moderate CRI, and severe CRI (serum creatinine ≥ 3 or GFR < 30 mL/min/1.73 m(2)). Major adverse events ([MAE] stroke, death, and myocardial infarction) were compared for all groups.
Using serum creatinine, perioperative stroke rates for normal, moderate, and severe CRI were: 5%, 0%, and 25%, respectively, (p = 0.05) vs 4.6%, 3.7%, and 11.1%, respectively, (p = 0.44) using GFR. The perioperative MAE rates for symptomatic patients were 9.3% and 0% (p = 0.355) and 2% and 5.9% (p = 0.223) for asymptomatic patients for normal and moderate/severe CRI, respectively, using serum creatinine vs 8.1% and 7.8%, respectively, for symptomatic patients and 2.5% and 3%, respectively, for asymptomatic patients using GFR. At a mean follow-up of 21 months, late MAE rates in normal vs moderate/severe CRI patients were 8.2% and 14%, respectively, (p = 0.247) using serum creatinine vs 6.6% and 13.3%, respectively, (p = 0.05) using GFR. Late MAE rates for symptomatic patients in normal vs moderate/severe CRI were: 8.7% vs 27%, respectively, (p = 0.061) using serum creatinine and 5.7% vs 18.8%, respectively, (p = 0.026) using GFR. Late death rate was 0.55% in normal vs 7.6% (p = 0.002) for moderate/severe CRI. Freedom from MAE at 3 years in symptomatic patients was 81% in normal and 46% in moderate/severe CRI (p = 0.0198). A multivariate Cox regression analysis showed that a GFR of < 60 mL/min/1.73 m(2) had an odds ratio of 1.6 (p = 0.222) of having a MAE after CAS.
The GFR was more sensitive in detecting late MAE after CAS. Carotid artery stenting in moderate CRI patients can be done with a satisfactory perioperative outcome; however, late death was significant.
本研究通过血清肌酐和肾小球滤过率（GFR）分析慢性肾功能不全（CRI）对颈动脉支架置入术（CAS）早期和晚期临床结局的影响。
313 例 CAS 患者分为 3 组：正常组（血清肌酐＜1.5mg/dL 或 GFR≥60mL/min/1.73m²）；中度 CRI 组和重度 CRI 组（血清肌酐≥3 或 GFR＜30mL/min/1.73m²）。比较各组的主要不良事件（MAE：卒中、死亡和心肌梗死）。
使用血清肌酐时，正常、中度和重度 CRI 患者的围手术期卒中发生率分别为 5%、0%和 25%（p=0.05）和 4.6%、3.7%和 11.1%（p=0.44），使用 GFR 时。症状性患者的围手术期 MAE 发生率分别为 9.3%和 0%（p=0.355）和 2%和 5.9%（p=0.223），无症状患者中正常和中度/重度 CRI 分别为 8.1%和 7.8%，症状性患者为 2.5%和 3%，无症状患者为 GFR。在平均 21 个月的随访中，正常与中度/重度 CRI 患者的晚期 MAE 发生率分别为 8.2%和 14%（p=0.247）和 6.6%和 13.3%（p=0.05）。正常与中度/重度 CRI 患者症状性患者的晚期 MAE 发生率分别为 8.7%和 27%（p=0.061）和 5.7%和 18.8%（p=0.026）。使用 GFR 时。正常和中度/重度 CRI 的晚期死亡率分别为 0.55%和 7.6%（p=0.002）。症状性患者 3 年无 MAE 率在正常组为 81%，在中度/重度 CRI 组为 46%（p=0.0198）。多变量 Cox 回归分析显示，GFR＜60mL/min/1.73m²的 MAE 发生风险比为 1.6（p=0.222）。
GFR 更能检测 CAS 后晚期 MAE。中度 CRI 患者可进行颈动脉支架置入术，围手术期结果满意，但晚期死亡率较高。
