Grandjean-Thomsen Nicolas Lo, Marley Paul, Shadbolt Bruce, Farshid Ahmad
Australian National University Medical School, Acton, ACT, Australia.
Nephron. 2017;137(1):23-28. doi: 10.1159/000473863. Epub 2017 May 6.
BACKGROUND/AIM: Patients with severe chronic kidney disease (CKD) have a higher risk of adverse events after percutaneous coronary intervention (PCI). There is conflicting evidence regarding the benefit of drug-eluting stents (DES) in patients with CKD. This study is aimed at assessing the effect of mild-to-moderate CKD on PCI outcomes, and determining if DES reduce adverse events amongst these patients.
We used our PCI database to determine demographic, procedural and outcome variables for 1960 consecutive patients (October 2009-October 2012). Kidney function was measured by the estimated glomerular filtration rate (eGFR - CKD-Epidemiology Collaboration creatinine based). Multivariate analysis was performed to determine independent variables associated with mortality and major adverse cardiovascular events (MACE).
The independent variables, predictive of 12-month mortality in PCI patients, were: age >64 years (hazard ratio [HR] 3.10 [95% CI 1.73-5.55], p < 0.001), 3-vessel disease (HR 1.72 [95% CI 1.10-2.68], p = 0.016) and CKD stage. Compared to stage 1 CKD (eGFR >89), HR of death increased in a progressive pattern below eGFR <75: eGFR 60-74, HR 2.40 (95% CI 1.2-4.78), p = 0.013, eGFR 45-59, HR 3.27 (95% CI 1.55-6.9), p = 0.002, eGFR 30-44, HR 4.10 (95% CI 1.82-9.24), p = 0.001, eGFR <30, HR 7.97 (95% CI 3.65-17.40), p < 0.001. In patients with eGFR <75, multivariate analysis demonstrated that DES use was an independent predictor of lower MACE (HR BMS vs. DES 1.8, p = 0.0044).
Age, severity of CKD and 3-vessel disease were independent predictors of mortality following PCI. The mortality risk in CKD patients increased progressively with eGFR <75. The use of DES was associated with a lower rate of MACE in CKD patients with eGFR <75.
背景/目的：重度慢性肾脏病（CKD）患者经皮冠状动脉介入治疗（PCI）后发生不良事件的风险更高。关于药物洗脱支架（DES）对CKD患者的益处，证据存在矛盾。本研究旨在评估轻至中度CKD对PCI结果的影响，并确定DES是否能减少这些患者的不良事件。
我们使用PCI数据库确定了1960例连续患者（2009年10月至2012年10月）的人口统计学、手术及结果变量。通过估算肾小球滤过率（eGFR - 基于CKD-Epidemiology协作组肌酐公式）来测量肾功能。进行多变量分析以确定与死亡率和主要不良心血管事件（MACE）相关的独立变量。
PCI患者12个月死亡率的独立预测变量为：年龄>64岁（风险比[HR] 3.10 [95%可信区间1.73 - 5.55]，p < 0.001）、三支血管病变（HR 1.72 [95%可信区间1.10 - 2.68]，p = 0.016）和CKD分期。与CKD 1期（eGFR>89）相比，eGFR<75时死亡风险呈渐进性增加：eGFR 60 - 74，HR 2.40（95%可信区间1.2 - 4.78），p = 0.013；eGFR 45 - 59，HR 3.27（95%可信区间1.55 - 6.9），p = 0.002；eGFR 30 - 44，HR 4.10（95%可信区间1.82 - 9.24），p = 0.001；eGFR<30，HR 7.97（95%可信区间3.65 - 17.40），p < 0.001。在eGFR<75的患者中，多变量分析表明使用DES是较低MACE的独立预测因素（BMS与DES相比HR为1.8，p = 0.0044）。
年龄、CKD严重程度和三支血管病变是PCI后死亡率的独立预测因素。CKD患者中，eGFR<75时死亡风险逐渐增加。在eGFR<75的CKD患者中，使用DES与较低的MACE发生率相关。
