Hernando Lorenzo, Canovas Ester, Freites Alfonso, de la Rosa Adriana, Alonso Javier, del Castillo Roberto, Salinas Pablo, Montalvo Gema Beatriz, Huelmos Ana Isabel, Botas Javier
Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2015 Apr;68(4):310-6. doi: 10.1016/j.rec.2014.04.016. Epub 2014 Sep 26.
The aim of this study was to analyze the prevalence, risk factors, and short- and long-term prognosis of patients with acute coronary syndrome and normal renal function who developed percutaneous coronary intervention-associated nephropathy.
This was an observational, retrospective, single-center study with a prospective follow-up of 470 consecutive patients hospitalized for acute coronary syndrome (not in cardiogenic shock) who underwent percutaneous coronary intervention, with no preexisting renal failure (admission creatinine ≤ 1.3mg/dL). Percutaneous coronary intervention-associated was defined as an increase in baseline creatinine ≥ 0.5 mg/dL or ≥ 25% baseline. The mean follow-up was 26.7 (14) months.
Of the 470 patients, 30 (6.4%) developed percutaneous coronary intervention-associated nepfhropathy. The independent predictors for acute renal failure were admission hemoglobin level (odds ratio = 0.71) and maximum troponin I level prior to the procedure (odds ratio = 1.02). During the long-term follow-up, the patients whose renal function deteriorated had a higher incidence of total mortality (5 [16.7%] vs 27 [6.1%]; P = .027). In the Cox regression analysis, percutaneous coronary intervention-associated nepfhropathy was not an independent predictor for total mortality, but could be a predictor for cardiac mortality (hazard ratio=5.4; 95% confidence interval 1.35-21.3; P = .017).
Percutaneous coronary intervention-associated nephropathy in patients with acute coronary syndrome and normal preexisting renal function is not uncommon and influences long-term survival.
本研究旨在分析急性冠脉综合征且肾功能正常的患者发生经皮冠状动脉介入治疗相关性肾病的患病率、危险因素以及短期和长期预后。
这是一项观察性、回顾性、单中心研究，对470例因急性冠脉综合征（非心源性休克）住院并接受经皮冠状动脉介入治疗且入院时无肾衰竭（入院时肌酐≤1.3mg/dL）的连续患者进行前瞻性随访。经皮冠状动脉介入治疗相关性肾病定义为基线肌酐升高≥0.5mg/dL或≥基线值的25%。平均随访时间为26.7（14）个月。
470例患者中，30例（6.4%）发生了经皮冠状动脉介入治疗相关性肾病。急性肾衰竭的独立预测因素为入院时血红蛋白水平（比值比=0.71）和术前肌钙蛋白I最高水平（比值比=1.02）。在长期随访中，肾功能恶化的患者全因死亡率较高（5例[16.7%]对27例[6.1%]；P=0.027）。在Cox回归分析中，经皮冠状动脉介入治疗相关性肾病不是全因死亡的独立预测因素，但可能是心脏死亡的预测因素（风险比=5.4；95%置信区间1.35-21.3；P=0.017）。
急性冠脉综合征且入院时肾功能正常的患者发生经皮冠状动脉介入治疗相关性肾病并不少见，且会影响长期生存。
