接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，对比剂诱导的急性肾损伤和缺氧性肝损伤合并存在对预后的影响：来自星际注册研究的结果
Prognostic Impact of Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry.
作者信息
Park Sang-Don, Moon Jeonggeun, Kwon Sung Woo, Suh Young Ju, Kim Tae-Hoon, Jang Ho-Jun, Suh Jon, Park Hyun Woo, Oh Pyung Chun, Shin Sung-Hee, Woo Seong-Il, Kim Dae-Hyeok, Kwan Jun, Kang WoongChol
机构信息
Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea.
Department of Cardiology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
出版信息
PLoS One. 2016 Jul 14;11(7):e0159416. doi: 10.1371/journal.pone.0159416. eCollection 2016.
BACKGROUND
Besides contrast-induced acute kidney injury(CI-AKI), adscititious vital organ damage such as hypoxic liver injury(HLI) may affect the survival in patients with ST-elevation myocardial infarction (STEMI). We sought to evaluate the prognostic impact of CI-AKI and HLI in STEMI patients who underwent primary percutaneous coronary intervention (PCI).
METHODS
A total of 668 consecutive patients (77.2% male, mean age 61.3±13.3 years) from the INTERSTELLAR STEMI registry who underwent primary PCI were analyzed. CI-AKI was defined as an increase of ≥0.5 mg/dL in serum creatinine level or 25% relative increase, within 48h after the index procedure. HLI was defined as ≥2-fold increase in serum aspartate transaminase above the upper normal limit on admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization and target vessel revascularization were recorded.
RESULTS
Over a mean follow-up period of 2.2±1.6 years, 94 MACCEs occurred with an event rate of 14.1%. The rates of MACCE and all-cause mortality were 9.7% and 5.2%, respectively, in the no organ damage group; 21.3% and 21.3% in CI-AKI group; 18.5% and 14.6% in HLI group; and 57.7% and 50.0% in combined CI-AKI and HLI group. Survival probability plots of composite MACCE and all-cause mortality revealed that the combined CI-AKI and HLI group was associated with the worst prognosis (p<0.0001 for both).
CONCLUSION
Combined CI-AKI after index procedure and HLI on admission is associated with poor clinical outcomes in patients with STEMI who underwent primary PCI. (INTERSTELLAR ClinicalTrials.gov number, NCT02800421.).
背景
除造影剂诱导的急性肾损伤（CI-AKI）外，诸如缺氧性肝损伤（HLI）等额外的重要器官损害可能会影响ST段抬高型心肌梗死（STEMI）患者的生存率。我们试图评估CI-AKI和HLI对接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者的预后影响。
方法
对来自INTERSTELLAR STEMI注册研究的668例连续接受直接PCI的患者（男性占77.2%，平均年龄61.3±13.3岁）进行分析。CI-AKI定义为在首次手术操作后48小时内血清肌酐水平升高≥0.5mg/dL或相对升高25%。HLI定义为入院时血清天冬氨酸转氨酶高于正常上限2倍以上。根据患者的CI-AKI和HLI状态将其分为四组。记录主要不良心血管和脑血管事件（MACCE），其定义为全因死亡率、非致死性心肌梗死、非致死性卒中、缺血驱动的靶病变血运重建和靶血管血运重建的综合情况。
结果
在平均2.2±1.6年的随访期内，发生94例MACCE，事件发生率为14.1%。在无器官损害组中，MACCE和全因死亡率分别为9.7%和5.2%；CI-AKI组中分别为21.3%和21.3%；HLI组中分别为18.5%和14.6%；CI-AKI合并HLI组中分别为57.7%和50.0%。复合MACCE和全因死亡率的生存概率图显示，CI-AKI合并HLI组的预后最差（两者均p<0.0001）。
结论
首次手术操作后合并CI-AKI和入院时合并HLI与接受直接PCI的STEMI患者不良临床结局相关。（INTERSTELLAR临床试验注册号，NCT02800421。）
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