Roberts John K, McCullough Peter A
Division of Nephrology, Duke University Medical Center, Durham, NC; Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; and The Heart Hospital, Plano, TX.
Division of Nephrology, Duke University Medical Center, Durham, NC; Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; and The Heart Hospital, Plano, TX.
Adv Chronic Kidney Dis. 2014 Nov;21(6):472-9. doi: 10.1053/j.ackd.2014.08.005. Epub 2014 Oct 24.
Coronary heart disease is highly prevalent in patients with CKD, and survival after acute coronary syndrome (ACS) is worse compared with the general population. Many trials that define guidelines for cardiovascular disease excluded patients with kidney disease, leaving a gap between the evidence base and clinical reality. The underlying pathophysiology of vascular disease appears to be different in the setting of CKD. Patients with CKD are more likely to present with myocardial infarction and less likely to be diagnosed with ACS on admission compared with the general population. Patients with CKD appear to benefit with angiography and revascularization compared with medical management alone. However, the increased risk of in-hospital bleeding and risk of contrast-induced acute kidney injury are 2 factors that can limit overall benefit for some. Thus, judicious application of available therapies for the management of ACS is warranted to extend survival and reduce hospitalizations in this high-risk population. In this review, we highlight the clinical challenges and potential solutions for managing ACS in patients with CKD.
冠心病在慢性肾脏病患者中极为常见，与普通人群相比，急性冠脉综合征（ACS）后的生存率更低。许多确定心血管疾病指南的试验将肾病患者排除在外，导致证据基础与临床实际之间存在差距。在慢性肾脏病背景下，血管疾病的潜在病理生理学似乎有所不同。与普通人群相比，慢性肾脏病患者更易出现心肌梗死，入院时被诊断为急性冠脉综合征的可能性更小。与单纯药物治疗相比，慢性肾脏病患者接受血管造影和血运重建似乎更有益。然而，住院出血风险增加以及造影剂诱发的急性肾损伤风险是可能限制部分患者总体获益的两个因素。因此，明智地应用现有疗法来管理急性冠脉综合征，对于延长这一高危人群的生存期和减少住院次数是必要的。在本综述中，我们重点介绍了慢性肾脏病患者急性冠脉综合征管理中的临床挑战及潜在解决方案。
