Vashistha Vishal, Lee Meng, Wu Yi-Ling, Kaur Sukhdeep, Ovbiagele Bruce
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Neurology, Chang-Gung University College of Medicine, Chiayi, Taiwan.
Int J Cardiol. 2016 Nov 15;223:401-409. doi: 10.1016/j.ijcard.2016.07.175. Epub 2016 Aug 4.
Chronic kidney disease is increasing in prevalence. The association between low baseline estimated glomerular filtration rate (eGFR) and future myocardial infarction has not been comprehensively assessed.
A systematic review and meta-analysis of observational studies evaluating the risk for future myocardial infarction associated with eGFR <60 and 60-90ml/min/1.73m was completed. Data sources included PubMed, EMBASE, and the Cochrane Library. Included studies were required to have prospectively collected data, followed subjects for at least 6months, and reported baseline eGFR levels and the multivariable-adjusted relative risk for future myocardial infarction. A random effects model was used and subgroup analyses were conducted.
26 publications representing 41 observational cohorts were selected. In total, 1,986,850 participants with more than 35,752 documented myocardial infarctions (follow-up range: 9months to ~20years) were evaluated. eGFR <60ml/min/1.73m was associated with a relative risk of 1.52 (95% confidence interval 1.39-1.67; p<0.00001) while eGFR 60-90ml/min/1.73m was associated with a relative risk of 1.21 (1.09-1.34; p=0.0002) for myocardial infarction. Significant heterogeneity existed among both eGFR groups. Subgroup analysis found a further increase in risk for myocardial infarction as eGFR declined from 30 to 60 to <30ml/min/1.73m (1.40, 95% confidence interval, 1.21-1.61 vs.1.94, 95% confidence interval, 1.51-2.50; p=0.03).
Decreased baseline eGFR is independently associated with increased future myocardial infarction, and the risk increases with advanced renal insufficiency. Clinicians should be wary of acute coronary syndromes in patients with CKD.
慢性肾脏病的患病率正在上升。低基线估计肾小球滤过率（eGFR）与未来心肌梗死之间的关联尚未得到全面评估。
完成了一项系统评价和荟萃分析，纳入评估eGFR<60和60 - 90ml/min/1.73m与未来心肌梗死风险相关的观察性研究。数据来源包括PubMed、EMBASE和Cochrane图书馆。纳入的研究要求前瞻性收集数据，对受试者随访至少6个月，并报告基线eGFR水平和未来心肌梗死的多变量调整相对风险。采用随机效应模型并进行亚组分析。
选择了代表41个观察性队列的26篇出版物。总共评估了1,986,850名参与者，记录了超过35,752例心肌梗死（随访范围：9个月至约20年）。eGFR<60ml/min/1.73m与心肌梗死的相对风险为1.52（95%置信区间1.39 - 1.67；p<0.00001），而eGFR 60 - 90ml/min/1.73m与心肌梗死的相对风险为1.21（1.09 - 1.34；p = 0.0002）。两个eGFR组之间均存在显著异质性。亚组分析发现，随着eGFR从30降至60再降至<30ml/min/1.73m，心肌梗死风险进一步增加（1.40，95%置信区间，1.21 - 1.61对比1.94，95%置信区间，1.51 - 2.50；p = 0.03）。
基线eGFR降低与未来心肌梗死风险增加独立相关，且随着肾功能不全进展风险增加。临床医生应警惕慢性肾脏病患者发生急性冠状动脉综合征。
