Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm U1094, School of Medicine, University of Limoges, Limoges, France.
Department of Cardiology, Dupuytren University Hospital, Limoges, France.
Am J Cardiol. 2014 Oct 1;114(7):1029-34. doi: 10.1016/j.amjcard.2014.07.011. Epub 2014 Jul 24.
Several studies demonstrated the prognostic importance of renal failure and peripheral artery disease in patients undergoing coronary artery bypass grafting (CABG), but data regarding the prognostic value of renal artery disease in this context are scarce. We aimed to study the prevalence and prognostic value of renal artery disease in patients undergoing CABG. We assessed by duplex ultrasound the renal arteries of 429 consecutive patients who underwent CABG, of whom 401 had satisfactory imaging quality to detect >60% renal artery stenosis (RAS) and/or an elevated resistive index (ERI>0.80). Of the 401 subjects included (age 68±10 years, 83% men), 40 (10%) had RAS and 35 (9%) had ERI. Nine patients (2.2%) had both conditions. Patients were followed up for 12.4±7.0 months. The primary outcome was composite, including 30-day death, stroke, and/or myocardial infarction. In a multivariate model adjusted for age, gender, cardiovascular (CV) risk factors, renal function, chronic obstructive pulmonary disease, the use of off-pump CABG, CV co-morbidities, and drugs, the presence of ERI was strongly associated with the occurrence of the composite outcome (odds ratio 4.3, 95% confidence interval 1.7 to 9.9, p=0.0006). Similarly, ERI, not RAS, was significantly associated with the 30-day acute kidney disease and the midterm mortality, as well as fatal and nonfatal CV events. In conclusion, regardless of renal function and other factors, the renal resistive index is a strong predictor of CV and renal events after CABG. Renal duplex ultrasound can identify a subgroup of patients at high risk of CABG.
几项研究表明，在接受冠状动脉旁路移植术（CABG）的患者中，肾衰竭和外周动脉疾病具有预后意义，但关于这方面的肾动脉疾病的预后价值的数据却很少。我们旨在研究 CABG 患者中肾动脉疾病的患病率和预后价值。我们通过双功能超声评估了 429 例连续接受 CABG 的患者的肾动脉，其中 401 例有满意的成像质量来检测 >60%的肾动脉狭窄（RAS）和/或升高的阻力指数（ERI>0.80）。在包括的 401 名患者中（年龄 68±10 岁，83%为男性），40 名（10%）有 RAS，35 名（9%）有 ERI。9 名患者（2.2%）同时存在这两种情况。患者接受了 12.4±7.0 个月的随访。主要结果是复合结果，包括 30 天内死亡、中风和/或心肌梗死。在调整年龄、性别、心血管（CV）危险因素、肾功能、慢性阻塞性肺疾病、非体外循环 CABG 的使用、CV 合并症和药物后，多元模型显示 ERI 与复合结果的发生密切相关（比值比 4.3，95%置信区间 1.7 至 9.9，p=0.0006）。同样，与 30 天急性肾功能衰竭和中期死亡率以及致命和非致命的 CV 事件相关的是 ERI，而不是 RAS。总之，无论肾功能和其他因素如何，肾阻力指数都是 CABG 后 CV 和肾脏事件的强有力预测指标。肾双功能超声可以识别出 CABG 高危患者的亚组。
