Davlouros Periklis, Xanthopoulou Ioanna, Goudevenos John, Hamilos Michalis, Vavuranakis Emmanouil, Sitafidis George, Kanakakis Ioannis, Deftereos Spyridon, Alexopoulos Dimitrios
Department of Cardiology, Patras University Hospital, Patras, Greece.
Cardiology. 2017;138(3):186-194. doi: 10.1159/000477798. Epub 2017 Jul 28.
To assess the clinical impact of impaired renal function (IRF), in "real-world" acute coronary syndrome (ACS) patients, receiving clopidogrel, prasugrel, or ticagrelor.
This was a prospective, observational, multicenter, cohort study of ACS patients undergoing percutaneous coronary interventions (PCI) with IRF (creatinine clearance <60 mL/min by Cockroft-Gault equation), who were recruited into the Greek Antiplatelet Registry (GRAPE). Patients were followed-up until 1 year for major adverse cardiovascular events (MACE; a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and BARC (Bleeding Academic Research Consortium) bleeding.
Out of 2,047 registered patients, there were 344 (16.8%) with IRF. At the 1-year follow-up, MACE occurred in 18.6 and 6.2% of those patients with and without IRF, respectively: adjusted hazard ratio (HR) = 2.13 (95% confidence interval, CI 1.16-3.91), p = 0.02. IRF patients were also at higher risk of death and BARC type ≥2 and ≥3 bleeding: adjusted HR = 3.55 (95% CI 1.73-7.27), p = 0.001; HR = 2.75 (95% CI 1.13-6.68), p = 0.03; and HR = 6.02 (95% CI 2.30-15.77), p < 0.001, respectively. Combined MACE and BARC type ≥2 bleeding occurred in 34.0 and 14.0% of those with and without IRF, respectively: adjusted HR = 2.65 (95% CI 1.36-5.16), p = 0.004. At discharge, clopidogrel was more frequently prescribed in IRF patients (61.0 vs. 33.1%, p < 0.001).
Real-world ACS patients with IRF subjected to PCI demonstrate higher thrombotic and bleeding risks than patients with normal renal function.
评估接受氯吡格雷、普拉格雷或替格瑞洛治疗的“真实世界”急性冠状动脉综合征（ACS）患者中肾功能受损（IRF）的临床影响。
这是一项针对接受经皮冠状动脉介入治疗（PCI）且伴有IRF（根据Cockcroft-Gault公式计算，肌酐清除率<60 mL/min）的ACS患者的前瞻性、观察性、多中心队列研究，这些患者被纳入希腊抗血小板登记系统（GRAPE）。对患者进行随访直至1年，观察主要不良心血管事件（MACE；包括死亡、非致命性心肌梗死、紧急血运重建和中风的复合事件）和BARC（出血学术研究联盟）出血情况。
在2047例登记患者中，有344例（16.8%）存在IRF。在1年随访时，有IRF和无IRF的患者中MACE发生率分别为18.6%和6.2%：调整后风险比（HR）=2.13（95%置信区间，CI 1.16 - 3.91），p = 0.02。IRF患者死亡以及发生BARC≥2型和≥3型出血的风险也更高：调整后HR = 3.55（95% CI 1.73 - 7.27），p = 0.001；HR = 2.75（95% CI 1.13 - 6.68），p = 0.03；以及HR = 6.02（95% CI 2.30 - 15.77），p < 0.001。合并MACE和BARC≥2型出血在有IRF和无IRF的患者中发生率分别为34.0%和14.0%：调整后HR = 2.65（95% CI 1.36 - 5.16），p = 0.004。出院时，IRF患者中氯吡格雷的处方更为频繁（61.0%对33.1%，p < 0.001）。
接受PCI的“真实世界”IRF ACS患者血栓形成和出血风险高于肾功能正常的患者。
