Liu Yong, Liu Yuanhui, Li Hualong, Zhou Yingling, Guo Wei, Duan Chongyang, Chen Shiqun, Chen Pingyan, Tan Ning, Chen Jiyan
Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.
National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
Sci Rep. 2016 Feb 22;6:21426. doi: 10.1038/srep21426.
We investigated whether attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) would improve the prognosis in patients with renal insufficiency at high risk of contrast-induced nephropathy (CIN). We analyzed 2,330 consecutive patients with renal insufficiency with or without CTOs who underwent coronary angiography or PCI from prospectively collected data. The long-term death and risk of CIN were evaluated among three groups: patients without CTOs (group A, n = 1,829), patients with un-attempted PCI for CTOs (group B, n = 142), and patients who underwent attempted PCI for CTOs (group C, n = 359). Overall, group B and group C (successful rate, 89%) patients had similar renal function and were not significantly associated with an increased risk of CIN (adjusted odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.41-1.93, P = 0.758). During a 2.33-year period (median), multivariate analysis demonstrated that attempted PCI for CTOs was independently associated with lower mortality (adjusted hazard ratio for death: 0.38, 95% CI: 0.18-0.83; P = 0.015). Attempted PCI for CTOs improved the long-term prognosis in patients with high-risk renal insufficiency and did not increase the risk of CIN.
我们研究了针对慢性完全闭塞病变（CTO）尝试进行经皮冠状动脉介入治疗（PCI）是否会改善具有造影剂肾病（CIN）高风险的肾功能不全患者的预后。我们分析了2330例连续的肾功能不全患者，这些患者有或没有CTO病变，他们接受了冠状动脉造影或PCI治疗，数据来自前瞻性收集。在三组患者中评估了长期死亡情况和发生CIN的风险：无CTO病变的患者（A组，n = 1829）、未尝试对CTO病变进行PCI治疗的患者（B组，n = 142）以及尝试对CTO病变进行PCI治疗的患者（C组，n = 359）。总体而言，B组和C组（成功率89%）患者的肾功能相似，且与CIN风险增加无显著相关性（校正比值比[OR]=0.88，95%置信区间[CI]：0.41 - 1.93，P = 0.758）。在2.33年（中位数）期间，多变量分析表明，尝试对CTO病变进行PCI治疗与较低的死亡率独立相关（校正死亡风险比：0.38，95%CI：0.18 - 0.83；P = 0.015）。尝试对CTO病变进行PCI治疗改善了高风险肾功能不全患者的长期预后，且未增加CIN风险。
