慢性肾脏病而非糖尿病可预测ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后的30天预后：一项单中心经验
Chronic Kidney Disease, But Not Diabetes, Can Predict 30-Day Outcomes in Patients with ST-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention: A Single-Center Experience.
作者信息
Hung Cheng-Chung, Huang Wei-Chun, Chiou Kuan-Rau, Cheng Chin-Chang, Kuo Feng-Yu, Yang Jin-Shiou, Lin Ko-Long, Chiang Cheng-Hung, Hsiao Shin-Hung, Lai Chi-Cheng, Lin Tzu-Wen, Mar Guang-Yuan, Chiou Chuen-Wang, Liu Chun-Peng
机构信息
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan; ; Department of Physical Therapy, Fooyin University;
出版信息
Acta Cardiol Sin. 2013 Sep;29(5):395-403.
BACKGROUND
Patients with acute coronary syndrome and impaired renal function have been shown to have high mortality. However, there is scarce literature to date addressing the impact of diabetes mellitus (DM) and renal function on clinical outcomes of ST elevation myocardial infarction (STEMI) in Taiwan.
METHOD
This study enrolled 512 STEMI patients who received primary percutaneous coronary intervention. Patients were divided into 4 groups including group 1: patients without DM or CKD (nDM-nCKD); group 2: patients with DM but without CKD (DM-nCKD); group 3: patients with CKD but without DM (nDM-CKD); group 4: patients with DM and CKD (DM-CKD). Patients were also classified into four groups based on their estimated glomerular filtration rates (eGFR): stage 1 (eGFR ≥ 90 ml/min/1.73 m(2), n = 163), stage 2 (eGFR = 89-60 ml/min/1.73 m(2), n = 171), stage 3 (eGFR = 59-30 ml/min/1.73 m(2), n = 136), and stage 4 (eGFR < 30 ml/min/1.73 m(2), n = 42). The complication rates, length of hospital stay, and 30-day outcomes were analyzed.
RESULTS
The patients in both the nDM-CKD group and DM-CKD group had higher incidences of hypotension, intra-aortic balloon counterpulsation use, and respiratory failure (p < 0.005). They had significantly longer hospital stay and 30-day mortality rates (p < 0.001). The patients with CKD stage 3 and 4 had longer hospital stay and higher 30-day mortality rates (p < 0.001). However, DM was not an independent factor on the length of hospital stay and 30-day mortality rates.
CONCLUSIONS
STEMI patients with impaired renal function, but not DM, had significantly longer hospital stay and higher 30-day mortality rates.
KEY WORDS
Chronic kidney disease; Diabetes mellitus; Mortality; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction.
背景
急性冠状动脉综合征和肾功能受损的患者已被证明具有较高的死亡率。然而，迄今为止，台湾地区关于糖尿病（DM）和肾功能对ST段抬高型心肌梗死（STEMI）临床结局影响的文献较少。
方法
本研究纳入了512例行直接经皮冠状动脉介入治疗的STEMI患者。患者被分为4组，包括：第1组：无DM或慢性肾脏病（CKD）的患者（非DM-非CKD）；第2组：有DM但无CKD的患者（DM-非CKD）；第3组：有CKD但无DM的患者（非DM-CKD）；第4组：有DM和CKD的患者（DM-CKD）。患者还根据其估计肾小球滤过率（eGFR）分为4组：1期（eGFR≥90 ml/min/1.73 m²，n = 163），2期（eGFR = 89 - 60 ml/min/1.73 m²，n = 171），3期（eGFR = 59 - 30 ml/min/1.73 m²，n = 136），4期（eGFR < 30 ml/min/1.73 m²，n = 42）。分析并发症发生率、住院时间和30天结局。
结果
非DM-CKD组和DM-CKD组患者低血压、主动脉内球囊反搏使用和呼吸衰竭的发生率更高（p < 0.005）。他们的住院时间显著更长，30天死亡率更高（p < 0.001）。CKD 3期和4期患者的住院时间更长，30天死亡率更高（p < 0.001）。然而，DM不是住院时间和30天死亡率的独立影响因素。
结论
肾功能受损而非DM的STEMI患者住院时间显著更长，30天死亡率更高。
关键词
慢性肾脏病；糖尿病；死亡率；直接经皮冠状动脉介入治疗；ST段抬高型心肌梗死
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