Leung Kelvin C W, Pannu Neesh, Tan Zhi, Ghali William A, Knudtson Merril L, Hemmelgarn Brenda R, Tonelli Marcello, James Matthew T
Departments of Medicine and.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1840-8. doi: 10.2215/CJN.03460414. Epub 2014 Oct 15.
AKI after coronary angiography is associated with poor long-term outcomes. The relationship between contrast-associated AKI and subsequent use of prognosis-modifying cardiovascular medications is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 5911 participants 66 years of age or older with acute coronary syndrome who received a coronary angiogram in Alberta, Canada was performed between November 1, 2002, and November 30, 2008. AKI was identified according to Kidney Disease Improving Global Outcomes AKI criteria.
In multivariable logistic regression models, compared with participants without AKI, those with stages 1 and 2-3 AKI had lower odds of subsequent use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker within 120 days of hospital discharge (adjusted odds ratio, 0.65; 95% confidence interval, 0.53 to 0.80 and odds ratio, 0.34; 95% confidence interval, 0.23 to 0.48, respectively). Subsequent statin and β-blockers use within 120 days of hospital discharge was significantly lower among those with stages 2-3 AKI (adjusted odds ratio, 0.44; 95% confidence interval, 0.31 to 0.64 and odds ratio, 0.46; 95% confidence interval, 0.31 to 0.66, respectively). These associations were consistently seen in patients with diabetes mellitus, heart failure, low baseline eGFR, and albuminuria; 952 participants died during subsequent follow-up after hospital discharge (mean=3.1 years). The use of each class of cardiovascular medication was associated with lower mortality, including among those who had experienced AKI.
Strategies to optimize the use of cardiac medications in people with AKI after coronary angiography might improve care.
冠状动脉造影术后发生急性肾损伤（AKI）与长期预后不良相关。对比剂相关AKI与后续使用改善预后的心血管药物之间的关系尚不清楚。
设计、地点、参与者及测量方法：对2002年11月1日至2008年11月30日期间在加拿大艾伯塔省接受冠状动脉造影的5911名66岁及以上急性冠状动脉综合征参与者进行了一项队列研究。根据改善全球肾脏病预后组织（KDIGO）的AKI标准确定AKI。
在多变量逻辑回归模型中，与未发生AKI的参与者相比，发生1期和2 - 3期AKI的参与者在出院后120天内使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的几率较低（校正比值比分别为0.65；95%置信区间为0.53至0.80和比值比为0.34；95%置信区间为0.23至0.48）。2 - 3期AKI患者出院后120天内他汀类药物和β受体阻滞剂的后续使用率也显著较低（校正比值比分别为0.44；95%置信区间为0.31至0.64和比值比为0.46；95%置信区间为0.31至0.66）。在糖尿病、心力衰竭、基线估算肾小球滤过率（eGFR）低和蛋白尿患者中均一致观察到这些关联；952名参与者在出院后的后续随访期间死亡（平均3.1年）。每类心血管药物的使用均与较低的死亡率相关，包括发生过AKI的患者。
优化冠状动脉造影术后AKI患者心脏药物使用的策略可能会改善治疗效果。
