Nakahashi Hidefumi, Kosuge Masami, Sakamaki Kentaro, Kiyokuni Masayoshi, Ebina Toshiaki, Hibi Kiyoshi, Tsukahara Kengo, Iwahashi Noriaki, Kuji Shotaro, Oba Mari S, Umemura Satoshi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Heart Vessels. 2017 Jan;32(1):22-29. doi: 10.1007/s00380-016-0836-8. Epub 2016 Apr 22.
Contrast-induced nephropathy (CIN) and chronic kidney disease (CKD) are associated with poor outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI); however, its combined prognostic significance remains unclear. We enrolled 577 patients with AMI undergoing primary PCI within 12 h after symptom onset and measured serum creatinine on admission and the next 3 days. CKD was defined as admission estimated glomerular filtration rate <60 ml/min/1.73 m, and CIN was defined as creatinine increase ≥0.5 mg/dl or ≥25 % from baseline within the first 72 h. Patients were stratified according to the presence or absence of CKD and CIN. In patients with no CKD and no CIN (n = 244), no CKD but CIN (n = 152), CKD but no CIN (n = 127), and both CKD and CIN (n = 54), the 3-year major adverse cardiovascular events (MACE: a combination of all-cause mortality, nonfatal reinfarction, or heart failure requiring rehospitalization) were 8, 9, 13, and 35 %, respectively (p < 0.001). Multivariate analysis showed that as compared with no CKD and no CIN, hazard ratios (95 % CI) for MACE associated with no CKD but CIN, CKD but no CIN, and both CKD and CIN were 0.91 (0.44-1.84; p = 0.79), 1.11 (0.5-2.23; p = 0.77), and 2.98 (1.48-6.04; p = 0.002), respectively. In patients with AMI undergoing primary PCI, the combination of CKD and CIN is significantly associated with adverse long-term outcomes.
造影剂肾病（CIN）和慢性肾脏病（CKD）与急性心肌梗死（AMI）患者接受直接经皮冠状动脉介入治疗（PCI）后的不良预后相关；然而，其联合预后意义仍不明确。我们纳入了577例症状发作后12小时内接受直接PCI的AMI患者，并在入院时及随后3天测量血清肌酐。CKD定义为入院时估计肾小球滤过率<60 ml/min/1.73 m²，CIN定义为在最初72小时内肌酐较基线水平升高≥0.5 mg/dl或≥25%。根据是否存在CKD和CIN对患者进行分层。在无CKD且无CIN（n = 244）、无CKD但有CIN（n = 152）、有CKD但无CIN（n = 127）以及既有CKD又有CIN（n = 54）的患者中，3年主要不良心血管事件（MACE：全因死亡率、非致死性再梗死或需要再次住院的心力衰竭的组合）发生率分别为8%、9%、13%和35%（p < 0.001）。多因素分析显示，与无CKD且无CIN相比，无CKD但有CIN、有CKD但无CIN以及既有CKD又有CIN的MACE风险比（95%CI）分别为0.91（0.44 - 1.84；p = 0.79）、1.11（0.5 - 2.23；p = 0.77）和2.98（1.48 - 6.04；p = 0.002）。在接受直接PCI的AMI患者中，CKD和CIN的联合与不良长期预后显著相关。
