Orvin Katia, Eisen Alon, Goldenberg Ilan, Farkash Ateret, Shlomo Nir, Gevrielov-Yusim Natalie, Iakobishvili Zaza, Hasdai David
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am Heart J. 2015 May;169(5):702-712.e3. doi: 10.1016/j.ahj.2015.01.012. Epub 2015 Feb 23.
The aim of this study is to determine the most accurate renal function formula that predicts short- and long-term mortality in a wide spectrum of acute coronary syndrome (ACS) patients.
We analyzed 8,726 consecutive patients (46.3% ST-elevation myocardial infarction [STEMI] and 53.7% non-ST-elevation ACS [NSTE-ACS]) enrolled in the ACS survey in Israel. Renal function, assessed using 5 formulas as proxies of creatinine clearance or estimated glomerular filtration rate (Cockcroft-Gault, modification of diet in renal disease [MDRD], Chronic Kidney Disease Epidemiology Collaboration, Mayo quadratic, and inulin clearance based), varied in applying the different formulas. For both STEMI and NSTE-ACS patients, the Mayo formula yielded the highest mean value (88.9 ± 27.7 and 81.4 ± 29.2 mL/min per 1.73 m(2), respectively) and Chronic Kidney Disease Epidemiology Collaboration the lowest (73.0 ± 23.1 and 67.0 ± 24.1 mL/min per 1.73 m(2), respectively). Using multivariate analysis, worse renal function was independently associated with increased mortality risk by 30% to 40% for each decrement of 10 U of creatinine clearance or estimated glomerular filtration rate in STEMI patients and by 25% to 30% for NSTE-ACS patients, using all 5 formulas. The only formula that more accurately predicted 1-year mortality than the MDRD formula was the Mayo quadratic formula with a 1-year net reclassification index of 0.26 and 0.14 for STEMI and NSTE-ACS patients, respectively, after multivariable adjustment.
Worse renal function was an independent predictor for short- and long-term mortality using all 5 formulas in a broad spectrum of ACS patients, but only the Mayo quadratic formula had better accuracy in predicting mortality relative to the MDRD, suggesting that it may be the preferred prognosticator among ACS patients.
本研究旨在确定能预测广泛急性冠状动脉综合征（ACS）患者短期和长期死亡率的最准确肾功能公式。
我们分析了以色列ACS调查中纳入的8726例连续患者（46.3%为ST段抬高型心肌梗死[STEMI]，53.7%为非ST段抬高型ACS[NSTE-ACS]）。使用5种公式评估肾功能作为肌酐清除率或估算肾小球滤过率的替代指标（Cockcroft-Gault公式、肾脏病饮食改良[MDRD]公式、慢性肾脏病流行病学协作组公式、梅奥二次公式以及基于菊粉清除率的公式），不同公式的应用结果存在差异。对于STEMI和NSTE-ACS患者，梅奥公式得出的平均值最高（分别为88.9±27.7和81.4±29.2 ml/min/1.73 m²），慢性肾脏病流行病学协作组公式得出的平均值最低（分别为73.0±23.1和67.0±24.1 ml/min/1.73 m²）。多变量分析显示，对于STEMI患者，每降低10 U肌酐清除率或估算肾小球滤过率，肾功能恶化与死亡风险增加30%至40%独立相关；对于NSTE-ACS患者，使用所有5种公式时，死亡风险增加25%至30%。在多变量调整后，唯一比MDRD公式更准确预测1年死亡率的公式是梅奥二次公式，STEMI和NSTE-ACS患者的1年净重新分类指数分别为0.26和0.14。
在广泛的ACS患者中，使用所有5种公式时，肾功能恶化都是短期和长期死亡率的独立预测因素，但相对于MDRD公式，只有梅奥二次公式在预测死亡率方面具有更高的准确性，这表明它可能是ACS患者中首选的预后指标。
