Cardiologia, Ospedale San Paolo, Dipartimento di Scienze della Salute, University of Milan, Italy.
Cardiologia, Ospedale San Paolo, Dipartimento di Scienze della Salute, University of Milan, Italy.
Int J Cardiol. 2014 Jun 1;174(1):37-42. doi: 10.1016/j.ijcard.2014.03.087. Epub 2014 Mar 20.
Patients undergoing primary percutaneous coronary intervention (PCI) are at high risk for contrast-induced nephropathy (CIN), a complication that has been demonstrated to negatively affect outcomes. It has been suggested that, when compared to males, female patients present higher incidence of CIN and higher mortality after primary PCI. However, the specific role of gender in this setting remains ill-defined given its complex interplay with several co-morbidities and clinical characteristics. We investigated the relationship of patients' variables, including gender, with CIN and mortality after primary PCI.
In a single center study in 323 consecutive patients undergoing primary PCI, the development of CIN and mortality during an 18-month median follow-up period was assessed. CIN was defined as an increase in serum creatinine (≥25% or ≥0.5 mg/dl) from baseline occurring at any time during the first 3 post-procedural days.
CIN occurred in 23 female and 26 male patients (25.0% vs 11.2%, p=0.003), while cumulative mortality was 10.6%. Women presented unfavorable basal characteristics and underwent myocardial reperfusion less quickly. At multivariable analysis, reduced left ventricular ejection fraction (LVEF) (odds ratio [OR] 7.32 95% confidence interval [CI]: 2.60-21, p<0.001) and female gender (OR 2.49 95%CI 1.22-5.07, p=0.01) predicted CIN, whereas the occurrence of CIN (hazard ratio [HR] 3.65 95%CI 1.55-8.59, p=0.003) and a Mehran risk score (MRS)≥6 (HR 1.76 95%CI 1.13-2.74, p=0.01) independently predicted long-term mortality.
After primary PCI, female gender and LVEF are associated with an increased risk of CIN, whereas MRS and development of CIN predict long-term mortality.
接受经皮冠状动脉介入治疗（PCI）的患者发生对比剂诱导肾病（CIN）的风险较高，这种并发症已被证明会对预后产生负面影响。与男性相比，女性患者发生 CIN 的发生率更高，且在接受 PCI 后死亡率更高。然而，鉴于其与多种合并症和临床特征的复杂相互作用，性别在这种情况下的具体作用仍不明确。我们研究了患者变量（包括性别）与接受 PCI 后的 CIN 和死亡率之间的关系。
在一项对 323 例连续接受 PCI 的患者进行的单中心研究中，评估了在 18 个月的中位随访期间发生 CIN 和死亡率的情况。CIN 的定义为在术后前 3 天的任何时间内血清肌酐升高（≥25%或≥0.5mg/dl）。
23 名女性和 26 名男性患者发生 CIN（25.0% vs 11.2%，p=0.003），而累积死亡率为 10.6%。女性患者的基础特征较差，且接受心肌再灌注的速度较慢。多变量分析显示，左心室射血分数（LVEF）降低（优势比[OR]7.32，95%置信区间[CI]：2.60-21，p<0.001）和女性性别（OR 2.49，95%CI 1.22-5.07，p=0.01）可预测 CIN，而 CIN 的发生（风险比[HR]3.65，95%CI 1.55-8.59，p=0.003）和 Mehran 风险评分（MRS）≥6（HR 1.76，95%CI 1.13-2.74，p=0.01）可独立预测长期死亡率。
在接受 PCI 后，女性性别和 LVEF 与 CIN 的风险增加相关，而 MRS 和 CIN 的发生可预测长期死亡率。
