Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta.
Duke Clinical Research Institute, Durham, NC, USA.
Eur Heart J Qual Care Clin Outcomes. 2018 Oct 1;4(4):274-282. doi: 10.1093/ehjqcco/qcx042.
Patients with chronic kidney disease (CKD) have been under-represented in stable ischaemic heart disease (SIHD) trials despite their heightened risk of cardiovascular mortality. We examine associations between kidney disease, treatment selection, and long-term survival in patients with SIHD.
SIHD patients with angiographically significant stenosis (≥70%) were categorized by renal function [dialysis-dependent, severe CKD [estimated glomerular filtration rate (eGFR) < 30], mild-moderate CKD (eGFR 30-59), and no CKD (eGFR ≥ 60)] and by treatment groups [revascularization ≤3 months of angiogram (percutaneous coronary intervention or coronary artery bypass surgery) vs. medical therapy]. The association between renal function category and treatment on long-term survival was examined and adjusted for differences in age, sex, co-morbidities, and coronary anatomy. Of the 17 910 SIHD patients, 0.7% (n = 118) were dialysis-dependent, 1.2% (n = 215) severe CKD, 12.0% (n = 2157) mild-moderate CKD, and 86.1% (n = 15420) no CKD. The presence of CKD was associated with significantly lower adjusted odds of receiving revascularization [reference no CKD: dialysis-dependent: odds ratio (OR) 0.52 (0.35, 0.79), severe (non-dialysis) CKD: OR 0.54 (0.40, 0.73), and mild-moderate CKD: OR 0.80 (0.71, 0.89)]. Over a median follow-up of 8.0 (interquartile range 3.2) years, patients with progressive CKD had higher long-term mortality (dialysis-dependent, 53.4%; severe CKD, 30.2%; mild-moderate CKD, 22.2%; no CKD, 11.9%, Ptrend < 0.0001). Revascularization was associated with improved long-term survival [adjusted hazard ratio (HR): dialysis-dependent: HR 0.29 (0.15, 0.55), severe CKD: HR 0.63 (0.36, 1.08), mild-moderate CKD: HR 0.49 (0.40, 0.60), and no CKD: HR 0.47 (0.42, 0.52)] (Pinteraction < 0.001).
In SIHD, the presence of CKD was accompanied by lower revascularization rates and a higher risk of mortality. However, revascularization in CKD was associated with improved long-term survival.
尽管慢性肾脏病（CKD）患者心血管死亡率升高，但在稳定型缺血性心脏病（SIHD）试验中，他们的代表性不足。我们研究了 SIHD 患者的肾脏疾病、治疗选择与长期生存之间的关系。
根据肾功能[透析依赖、严重 CKD（估计肾小球滤过率[eGFR]＜30）、轻度至中度 CKD（eGFR 30-59）和无 CKD（eGFR≥60）]和治疗组[血管造影后 3 个月内进行血运重建（经皮冠状动脉介入治疗或冠状动脉旁路移植术）与药物治疗]，对血管造影显示有显著狭窄（≥70%）的 SIHD 患者进行分类。研究了肾功能类别与长期生存之间的关联，并对年龄、性别、合并症和冠状动脉解剖结构的差异进行了调整。在 17910 例 SIHD 患者中，0.7%（n=118）为透析依赖，1.2%（n=215）为严重 CKD，12.0%（n=2157）为轻度至中度 CKD，86.1%（n=15420）为无 CKD。存在 CKD 与接受血运重建的可能性显著降低相关[无 CKD 为参考：透析依赖：比值比（OR）0.52（0.35，0.79），非透析严重（非透析）CKD：OR 0.54（0.40，0.73），轻度至中度 CKD：OR 0.80（0.71，0.89）]。中位随访 8.0 年（四分位距 3.2 年）后，CKD 进展患者的长期死亡率较高（透析依赖：53.4%；严重 CKD：30.2%；轻度至中度 CKD：22.2%；无 CKD：11.9%，P趋势<0.0001）。血运重建与长期生存改善相关[校正后的危险比（HR）：透析依赖：HR 0.29（0.15，0.55），严重 CKD：HR 0.63（0.36，1.08），轻度至中度 CKD：HR 0.49（0.40，0.60），无 CKD：HR 0.47（0.42，0.52）]（P 交互<0.001）。
在 SIHD 中，存在 CKD 与较低的血运重建率和更高的死亡率相关。然而，CKD 患者的血运重建与长期生存的改善相关。
