Karetnikova V N, Kalaeva V V, Evseeva M V, Osokina A V, Kashtalap V V, Gruzdeva O V, Shafranskaya K S, Zykov M V, Barbarash O L
Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia; Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia.
Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia.
Ter Arkh. 2016;88(6):26-32. doi: 10.17116/terarkh201688626-32.
To evaluate the prognostic impact of chronic kidney disease (CKD) during hospital stay in patients with ST-segment elevation myocardial infarction (STEMI) and to specify factors showing a negative impact of CKD.
954 patients with STEMI were examined. The diagnosis of CKD was verified in 338 (35.4%). In all the patients, glomerular filtration rate (GFR) was calculated using the CKD-EPI formula with regard to serum creatinine levels on admission and before discharge (on days 10--12). In the patients who had undergone X-ray contrast intervention, serum creatinine levels were additionally determined on days 2--3 of this procedure in order to identify contrast-induced nephropathy (CIN). Cardiovascular events were assessed in the hospital period.
Endovascular interventions into the coronary vessels were made much more rarely in the patients with CHD; but CIN cases were twice more commonly recorded. Nonfatal cardiovascular events were 1.5 times more frequently observed in the CKD patients in the hospital period. The odds of fatal outcomes in both the total sample of STEMI patients and in those with CKD increased by 3.5 and 3.1 times, respectively, in the over 60 age group and by 7.9 and 5.8 times in the presence of Killip Classes II--IV clinically relevant acute heart failure (AHF). In the total sample, the independent predictors for a fatal outcome were a decreased admission GFR less than 60 ml/min/1.73 m(2), CIN, and Killip II--IV AHF. The hospital nonfatal complications were also associated with a decreased admission GFR less than 60 ml/min/1.73 m(2).
The independent predictor of a poor hospital period of STEMI, including fatal outcomes, was a decreased admission GFR less than 60 ml/min/1.73 m(2); the presence of CKD was of no independent value.
评估慢性肾脏病（CKD）对ST段抬高型心肌梗死（STEMI）患者住院期间预后的影响，并明确显示CKD具有负面影响的因素。
对954例STEMI患者进行检查。338例（35.4%）确诊为CKD。所有患者均根据入院时和出院前（第10 - 12天）的血清肌酐水平，使用CKD-EPI公式计算肾小球滤过率（GFR）。对于接受X线造影剂干预的患者，在该操作的第2 - 3天额外测定血清肌酐水平，以识别造影剂肾病（CIN）。评估住院期间的心血管事件。
冠心病患者进行冠状动脉血管内介入治疗的情况少见得多，但CIN病例的记录频率是前者的两倍。住院期间，CKD患者发生非致命性心血管事件的频率高出1.5倍。在60岁以上年龄组中，STEMI患者总样本和CKD患者的死亡几率分别增加3.5倍和3.1倍，在存在Killip II - IV级临床相关急性心力衰竭（AHF）的情况下分别增加7.9倍和5.8倍。在总样本中，死亡结局的独立预测因素是入院时GFR降低至低于60 ml/min/1.73 m²、CIN以及Killip II - IV级AHF。住院非致命并发症也与入院时GFR降低至低于60 ml/min/1.73 m²有关。
STEMI患者住院期间预后不良（包括死亡结局）的独立预测因素是入院时GFR降低至低于60 ml/min/1.73 m²；CKD的存在无独立预测价值。
