Stanford University School of Medicine, Stanford, California.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
J Am Coll Cardiol. 2014 Sep 9;64(10):985-94. doi: 10.1016/j.jacc.2014.04.077.
Acute kidney injury (AKI) is a known complication after coronary revascularization, but few studies have directly compared the incidence of AKI after coronary artery bypass surgery (CABG) or after percutaneous coronary intervention (PCI) in similar patients.
The aim of this study was to investigate whether multivessel CABG compared with PCI as an initial revascularization strategy is associated with a higher risk for AKI.
A retrospective analysis of patients undergoing first documented coronary revascularization was conducted using 2 complementary cohorts: 1) Kaiser Permanente Northern California, a diverse, integrated health care delivery system; and 2) Medicare beneficiaries, a large, nationally representative older cohort. AKI was defined in the Kaiser Permanente Northern California cohort by an increase in serum creatinine of ≥0.3 mg/dl or ≥150% above baseline and in the Medicare cohort by discharge diagnosis codes and the use of dialysis.
The incidence of AKI was 20.4% in the Kaiser Permanente Northern California cohort and 6.2% in the Medicare cohort. The incidence of AKI requiring dialysis was <1%. CABG was associated with a 2- to 3-fold significantly higher adjusted odds for developing AKI compared with PCI in both cohorts.
AKI is common after multivessel coronary revascularization and is more likely after CABG than after PCI. The risk for AKI should be considered when choosing a coronary revascularization strategy, and ways to prevent AKI after coronary revascularization are needed.
急性肾损伤（AKI）是冠状动脉血运重建后的已知并发症，但很少有研究直接比较过在相似患者中，冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）后 AKI 的发生率。
本研究旨在探讨多支血管 CABG 与 PCI 作为初始血运重建策略相比，是否与 AKI 风险增加相关。
采用 2 个互补队列对首次明确记录的冠状动脉血运重建患者进行回顾性分析：1）凯撒永久北方加利福尼亚州，一个多样化、集成的医疗保健提供系统；2）医疗保险受益人，一个大型、具有全国代表性的老年队列。在凯撒永久北方加利福尼亚州队列中，AKI 通过血清肌酐增加≥0.3mg/dl 或比基线升高≥150%来定义；在医疗保险队列中，通过出院诊断代码和透析的使用来定义。
在凯撒永久北方加利福尼亚州队列中 AKI 的发生率为 20.4%，在医疗保险队列中为 6.2%。需要透析的 AKI 发生率<1%。在两个队列中，与 PCI 相比，CABG 与 AKI 发展的调整后比值比增加 2-3 倍相关。
多支血管冠状动脉血运重建后 AKI 很常见，且 CABG 后比 PCI 后更可能发生 AKI。在选择冠状动脉血运重建策略时应考虑 AKI 的风险，并且需要寻找预防冠状动脉血运重建后 AKI 的方法。
