Patel Brijesh, Shah Mahek, Dusaj Raman, Maynard Sharon, Patel Nainesh
Departments of Cardiology (Patel, Shah, Dusaj, Patel) and Nephrology (Maynard), Lehigh Valley Hospital, Allentown, Pennsylvania.
Proc (Bayl Univ Med Cent). 2017 Oct;30(4):400-403. doi: 10.1080/08998280.2017.11930205.
Chronic kidney disease (CKD) is an important risk factor for coronary artery disease, yet patients with CKD are less likely to undergo coronary angiography and percutaneous coronary intervention (PCI). We retrospectively analyzed the 2006-2012 National Inpatient Sample Database to examine the temporal trends in coronary angiography and PCI among patients without CKD, with advanced CKD (CKD III-V), and with end-stage renal disease (ESRD) presenting with unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). A total of 579,747 admissions for NSTE-ACS and 293,950 admissions for STEMI were studied. Patients with NSTE-ACS were less likely to undergo coronary angiography/PCI than those with STEMI, irrespective of CKD. Between 2006 and 2012, performance of PCI saw an uptrend across all CKD groups with NSTE-ACS (no CKD, 29.9%-36.8%; CKD III-V, 18.2%-21.5%; ESRD, 19.8%-27.5%; all < 0.01) and STEMI (no CKD, 57.0%-76.0%; CKD III-V, 33.0%-52.6%; ESRD, 29.9%-42.9%; < 0.01). Multivariate analyses revealed that PCI was associated with a lower risk of hospital mortality across all degrees of CKD in both NSTE-ACS (adjusted odds ratios: no CKD, 0.44; CKD III-V, 0.48; ESRD, 0.46; < 0.01) and STEMI (no CKD, 0.35; CKD III-V, 0.50; ESRD, 0.52; < 0.01). Performance of PCI increased over time among patients presenting with NSTE-ACS and STEMI in the presence of advanced CKD and independently predicted lower in-hospital mortality.
慢性肾脏病（CKD）是冠状动脉疾病的重要危险因素，但CKD患者接受冠状动脉造影和经皮冠状动脉介入治疗（PCI）的可能性较小。我们回顾性分析了2006 - 2012年国家住院患者样本数据库，以研究无CKD、晚期CKD（CKD III - V期）和终末期肾病（ESRD）且表现为不稳定型心绞痛/非ST段抬高型心肌梗死（NSTE - ACS）及ST段抬高型心肌梗死（STEMI）的患者在冠状动脉造影和PCI方面的时间趋势。共研究了579747例NSTE - ACS住院病例和293950例STEMI住院病例。无论是否患有CKD，NSTE - ACS患者接受冠状动脉造影/PCI的可能性均低于STEMI患者。在2006年至2012年期间，所有患有NSTE - ACS的CKD组（无CKD，29.9% - 36.8%；CKD III - V期，18.2% - 21.5%；ESRD，19.8% - 27.5%；P均<0.01）以及STEMI组（无CKD，57.0% - 76.0%；CKD III - V期，33.0% - 52.6%；ESRD，29.9% - 42.9%；P<0.01）的PCI实施率均呈上升趋势。多因素分析显示，在NSTE - ACS（校正比值比：无CKD，0.44；CKD III - V期，0.48；ESRD，0.46；P<0.01）和STEMI（无CKD，0.35；CKD III - V期，0.50；ESRD，0.52；P<0.01）中，PCI与所有程度CKD患者较低的住院死亡率相关。在患有晚期CKD且表现为NSTE - ACS和STEMI的患者中，PCI的实施率随时间增加，且独立预测较低的住院死亡率。
