Gupta Tanush, Paul Neha, Kolte Dhaval, Harikrishnan Prakash, Khera Sahil, Aronow Wilbert S, Mujib Marjan, Palaniswamy Chandrasekar, Sule Sachin, Jain Diwakar, Ahmed Ali, Cooper Howard A, Frishman William H, Bhatt Deepak L, Fonarow Gregg C, Panza Julio A
Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.).
Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.).
J Am Heart Assoc. 2015 Jun 16;4(6):e002069. doi: 10.1161/JAHA.115.002069.
The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.
We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease.
In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.
在当前药物洗脱支架和现代抗栓治疗时代，慢性肾功能不全与经皮冠状动脉介入治疗（PCI）后结局之间的关联尚未得到充分描述。
我们查询了2007 - 2011年全国住院患者样本数据库，以识别所有年龄≥18岁且接受PCI的患者。采用多变量逻辑回归比较慢性肾脏病（CKD）患者、终末期肾病（ESRD）患者以及无CKD或ESRD患者的住院结局。在3187404例接受PCI的患者中，89%无CKD/ESRD；8.6%有CKD；2.4%有ESRD。与无CKD/ESRD的患者相比，CKD患者和ESRD患者的住院死亡率更高（分别为1.4%、2.7%和4.4%；CKD的调整优势比为1.15，95%可信区间为1.12至1.19，P<0.001；ESRD的调整优势比为2.29，95%可信区间为2.19至2.40，P<0.001），术后出血发生率更高（分别为3.5%、5.4%和6.0%；CKD的调整优势比为1.21，95%可信区间为1.18至1.23，P<0.001；ESRD的调整优势比为1.27，95%可信区间为1.23至1.32，P<0.001），平均住院时间更长（分别为2.9天、5.0天和6.4天；P<0.001），平均总住院费用更高（分别为60526美元、77324美元和97102美元；P<0.001）。在因急性冠状动脉综合征或稳定型缺血性心脏病接受PCI的患者亚组中也观察到类似结果。
在接受PCI的患者中，慢性肾功能不全与更高的住院死亡率、更高的术后出血率、更长的平均住院时间以及更高的平均住院费用相关。
