肾功能不全与农村女性ST段抬高型急性心肌梗死患者再灌注治疗后的2年死亡率相关：一项多中心前瞻性研究。

Renal insufficiency was correlated with 2-year mortality for rural female patients with ST-segment elevation acute myocardial infarction after reperfusion therapy: a multicenter, prospective study.

作者信息

Gao Yuan, Jiang Daming, Zhang Bo, Sun Yujiao, Ren Lina, Fan Dandan, Qi Guoxian

机构信息

Department of Cardiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China.

Department of Cardiology, Dandong Center Hospital, Dandong, Liaoning, 118000, China.

出版信息

BMC Cardiovasc Disord. 2015 Dec 24;15:179. doi: 10.1186/s12872-015-0174-2.

DOI:10.1186/s12872-015-0174-2

PMID:26702638

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4690416/

Abstract

BACKGROUND

Renal insufficiency (RI) following ST-segment elevation acute myocardial infarction (STEMI) is associated with a worse clinical prognosis. We investigated the impact of RI on long-term mortality in rural female patients with STEMI and evaluated prognostic factors.

METHODS

A prospective cohort study of 436 consecutive rural female patients who were successfully treated with reperfusion therapy for STEMI between May 2009 and August 2011 in secondary care hospitals in Liaoning province northeastern China and followed up for 2 years. Patients were divided into three groups by estimated glomerular filtration rate (eGFR): Normal group, eGFR ≥90 mL/min/1.73 m(2) (n = 233). Moderate group, eGFR 60-90 mL/min/1.73 m(2) (n = 108). RI group, eGFR <60 mL/min/1.73 m(2) (n = 95). The primary outcome was 2-year mortality.

RESULTS

During follow-up (mean 741 ± 118 days), the RI group had a significantly higher mortality than the other groups (24.21 % vs. 6.87 % and 10.19 %, p < 0.001). The RI group had significantly higher hospital mortality (7.37 % p = 0.045 vs. Normal group). RI increased the risk of hospital mortality (hazard ratio (HR) 1.832, 95 % CI 1.017-3.091, p = 0.033), and increased the risk of 2-year mortality (HR 3.872, 95 % CI 2.004-6.131, p < 0.001). Multivariate analysis showed eGFR <90 ml/min/1.73 m(2) and age ≥75 years as independent predictors of mortality at 2 years. In detail these were eGFR 60-90 ml/min/1.73 m(2) with HR 2.081, 95%CI 1.250-2.842, p < 0.001; eGFR <60 ml/min/1.73 m(2) with HR 3.872, 95%CI 2.004-6.131, p < 0.001; age ≥75 with HR 1.461, 95%CI 1.011-1.952, p = 0.024.

CONCLUSIONS

RI had a powerful correlation with long-term mortality for rural female patients with STEMI after reperfusion therapy.

摘要

背景

ST段抬高型急性心肌梗死（STEMI）后出现的肾功能不全（RI）与更差的临床预后相关。我们研究了RI对农村STEMI女性患者长期死亡率的影响，并评估了预后因素。

方法

对2009年5月至2011年8月在中国东北辽宁省二级医院接受STEMI再灌注治疗且成功的436例连续农村女性患者进行前瞻性队列研究，并随访2年。根据估计肾小球滤过率（eGFR）将患者分为三组：正常组，eGFR≥90 mL/min/1.73m²（n = 233）；中度组，eGFR 60 - 90 mL/min/1.73m²（n = 108）；RI组，eGFR < 60 mL/min/1.73m²（n = 95）。主要结局为2年死亡率。

结果

在随访期间（平均741±118天），RI组的死亡率显著高于其他组（24.21%对6.87%和10.19%，p < 0.001）。RI组的院内死亡率显著更高（7.37%，p = 0.045，对比正常组）。RI增加了院内死亡风险（风险比（HR）1.832，95%可信区间1.017 - 3.091，p = 0.033），并增加了2年死亡风险（HR 3.872，95%可信区间2.004 - 6.131，p < 0.001）。多变量分析显示eGFR < 90 ml/min/1.73m²和年龄≥75岁是2年死亡率的独立预测因素。具体而言，这些因素为eGFR 60 - 90 ml/min/1.73m²，HR 2.081，95%CI 1.250 - 2.842，p < 0.001；eGFR < 60 ml/min/1.73m²，HR 3.872，95%CI 2.004 - 6.131，p < 0.001；年龄≥75岁，HR 1.461，95%CI 1.011 - 1.952，p = 0.024。