Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
Int J Cardiol. 2017 Dec 15;249:377-382. doi: 10.1016/j.ijcard.2017.09.175. Epub 2017 Sep 22.
Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated.
We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation.
The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13-2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15-2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15-4.88], p=0.02) and CMI (HR 4.02 [1.80-8.98], p=0.001) were associated with increased risk after renal transplantation.
SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.
患有晚期慢性肾脏病（CKD）的患者心肌梗死（MI）的风险增加。CKD 患者中常见无症状性心肌梗死（SMI），且与死亡率增加相关。尚未评估晚期 CKD 患者中 SMI 的患病率和预后价值。
我们在 2004 年 6 月至 2006 年 1 月期间，在阿拉巴马大学伯明翰分校鉴定了连续接受肾脏移植评估的患有晚期 CKD 的患者。通过回顾病历确定临床心肌梗死（CMI）。SMI 定义为心电图有 MI 证据而无 MI 临床病史。主要终点是死亡、MI 或冠状动脉血运重建的复合终点，在接受肾脏移植时进行删失。
该队列包括 1007 名年龄 48±12 岁（58%男性，43%糖尿病，75%透析）的晚期 CKD 患者。SMI 和 CMI 的患病率分别为 10.7%和 6.7%。SMI 的唯一独立预测因素是年龄较大（年龄≥50 岁的优势比为 2.32，p<0.001）。在中位随访 28 个月期间，376 名（37%）患者发生主要结局（33%死亡，2%MI，5%冠状动脉血运重建）。在多变量调整的 Cox 回归模型中，SMI（调整后的 HR 1.58，[1.13-2.20]，p=0.007）和 CMI（调整后的 HR 1.67 [1.15-2.43]，p=0.007）均与主要结局独立相关。此外，SMI（HR 2.37 [1.15-4.88]，p=0.02）和 CMI（HR 4.02 [1.80-8.98]，p=0.001）在接受肾脏移植后也与心血管事件风险增加相关。
SMI 在晚期 CKD 患者中比 CMI 更常见。SMI 和 CMI 均与未来心血管事件风险增加相关。
