Taduru Siva Sagar, Ramakrishnan Madhuri, Mustafa Reem A, Baweja Paramdeep S
Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Am J Cardiol. 2017 Oct 1;120(7):1104-1109. doi: 10.1016/j.amjcard.2017.06.047. Epub 2017 Jul 14.
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) are established modalities of coronary revascularization. Choosing between the two requires taking into consideration not only disease severity, patient characteristics, and expected outcomes but also adverse effects. One such adverse effect is acute kidney injury (AKI), especially when considering coronary revascularization in patients with renal transplant (RT). We searched the National Inpatient Sample from 2008 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for patients with RT (V42.0) who underwent PCI (00.66, 36.06, and 36.07) and CABG (36.1×, 36.2, and 36.3×). We further identified patients with AKI (584.5, 584.6, 584.7, 584.8, and 584.9) and those on dialysis (39.95). The propensity score model/method was used to form matched cohorts for PCI and CABG. We compared the incidence of AKI and AKI requiring dialysis in CABG and PCI groups. We identified 1,871 patients who underwent PCI and 1,878 patients who underwent CABG after propensity score matching. We found the incidence of both AKI (22% vs 38%, odds ratio 2.20, 95% confidence interval 1.91 to 2.54, p <0.0001) and AKI requiring dialysis (1% vs 3%, odds ratio 2.50, 95% confidence interval 1.49 to 4.19, p = 0.001) to be significantly higher in the CABG compared with the PCI cohort. In conclusion, the results of the study reflect the importance of accounting for the RT status before choosing between PCI and CABG for coronary revascularization.
经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）是已确立的冠状动脉血运重建方式。在这两种方式之间做出选择不仅需要考虑疾病严重程度、患者特征和预期结果，还需考虑不良反应。其中一种不良反应就是急性肾损伤（AKI），尤其是在考虑对肾移植（RT）患者进行冠状动脉血运重建时。我们使用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码，在2008年至2014年的全国住院患者样本中搜索接受PCI（00.66、36.06和36.07）和CABG（36.1×、36.2和36.3×）的RT患者（V42.0）。我们进一步确定了患有AKI（584.5、584.6、584.7、584.8和584.9）以及接受透析（39.95）的患者。倾向评分模型/方法用于为PCI和CABG形成匹配队列。我们比较了CABG组和PCI组中AKI以及需要透析的AKI的发生率。经过倾向评分匹配后，我们确定了1871例接受PCI的患者和1878例接受CABG的患者。我们发现，与PCI队列相比，CABG组中AKI（22%对38%，优势比2.20，95%置信区间1.91至2.54，p＜0.0001）以及需要透析的AKI（1%对3%，优势比2.50，95%置信区间1.49至4.19，p = 0.001）的发生率均显著更高。总之，研究结果反映了在冠状动脉血运重建的PCI和CABG之间做出选择之前，考虑RT状态的重要性。
