Akashi Naoyuki, Sakakura Kenichi, Watanabe Yusuke, Noguchi Masamitsu, Taniguchi Yousuke, Yamamoto Kei, Wada Hiroshi, Momomura Shin-Ichi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
Heart Vessels. 2018 Jul;33(7):713-721. doi: 10.1007/s00380-018-1122-8. Epub 2018 Jan 16.
Acute myocardial infarction (AMI) is more frequently observed in patients with chronic kidney disease (CKD) than in patients without CKD. Initial treatment strategy for AMI includes primary percutaneous coronary intervention (PCI), which requires substantial amount of contrast media. We hypothesized that the clinical outcomes are comparable or worse in patients with AMI and advanced CKD off chronic hemodialysis as compared to patients with AMI and advanced CKD on chronic hemodialysis. The purpose of this study was to compare the clinical outcomes of patients with AMI and advanced CKD on hemodialysis versus off hemodialysis. A total of 148 patients with estimated glomerular filtration rate < 30 ml/min/1.73 m on admission were included and were divided into the HD group (n = 68) and non-HD group (n = 80). The length of hospitalization was significantly less in the HD group (15.7 ± 14.8 days) than in the non-HD group (22.4 ± 21.3 days) (P = 0.01). In-hospital death was significantly less in the HD group (10.3%) than in the non-HD group (25.0%) (P = 0.02). While the non-HD group was not significantly associated with in-hospital death after controlling clinical covariates, the non-HD group (odd ratio 2.89, 95% confidence interval 1.03-8.12, P = 0.04) was significantly associated with long hospitalization even after controlling clinical covariates. In conclusion, as compared to advanced CKD on chronic hemodialysis, advanced CKD off hemodialysis had higher morbidity and mortality in patients with AMI. Advanced CKD off hemodialysis was closely associated with long hospitalization even after controlling clinical factors.
与无慢性肾脏病（CKD）的患者相比，急性心肌梗死（AMI）在CKD患者中更为常见。AMI的初始治疗策略包括直接经皮冠状动脉介入治疗（PCI），这需要大量的造影剂。我们假设，与接受慢性血液透析的AMI和晚期CKD患者相比，未接受慢性血液透析的AMI和晚期CKD患者的临床结局相当或更差。本研究的目的是比较接受血液透析和未接受血液透析的AMI和晚期CKD患者的临床结局。共纳入148例入院时估计肾小球滤过率<30 ml/min/1.73 m²的患者，并将其分为HD组（n = 68）和非HD组（n = 80）。HD组的住院时间（15.7±14.8天）显著短于非HD组（22.4±21.3天）（P = 0.01）。HD组的院内死亡率（10.3%）显著低于非HD组（25.0%）（P = 0.02）。虽然在控制临床协变量后，非HD组与院内死亡无显著相关性，但即使在控制临床协变量后，非HD组（比值比2.89，95%置信区间1.03 - 8.12，P = 0.04）仍与住院时间延长显著相关。总之，与接受慢性血液透析的晚期CKD相比，未接受血液透析的晚期CKD在AMI患者中具有更高的发病率和死亡率。即使在控制临床因素后，未接受血液透析的晚期CKD仍与住院时间延长密切相关。
