Naganuma Toru, Tsujita Kenichi, Mitomo Satoru, Ishiguro Hisaaki, Basavarajaiah Sandeep, Sato Katsumasa, Kobayashi Tsuyoshi, Obata Junei, Nagamatsu Suguru, Yamanaga Kenshi, Komura Naohiro, Sakamoto Kenji, Yamamoto Eiichiro, Izumiya Yasuhiro, Kojima Sunao, Kaikita Koichi, Ogawa Hisao, Nakamura Sunao
Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Am J Cardiol. 2018 Jun 15;121(12):1519-1523. doi: 10.1016/j.amjcard.2018.02.032. Epub 2018 Mar 13.
The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. A total of 1,463 patients underwent successful CTO-PCI between August 2004 and December 2014. Major adverse cardiovascular events (MACE) defined as the composite of all-cause death, myocardial infarction and target lesion revascularization, cardiac death, and stent thrombosis were compared between patients with and without CKD (555 and 908 patients, respectively). The results demonstrated higher risks of MACE (log-rank p = 0.015), all-cause death (log-rank p <0.001), and cardiac death (log-rank p <0.001) in the CKD group compared with the non-CKD group. Multivariable analyses demonstrated that CKD was an independent predictor for MACE (hazard ratio 1.23, 95% confidence interval 1.02 to 1.47, p = 0.03). With regard to pharmacotherapy, statin use was associated with significantly lower rates of MACE in the CKD group (log-rank p = 0.003). In conclusion, the presence of CKD would be an important predictor of long-term clinical outcomes in patients who underwent CTO-PCI, and use of statin may influence in reducing the adverse clinical outcomes.
慢性肾脏病（CKD）及潜在药物干预对慢性完全闭塞病变（CTO）经皮冠状动脉介入治疗（PCI）后临床结局的影响尚不清楚。2004年8月至2014年12月期间，共有1463例患者成功接受了CTO-PCI治疗。比较了有和没有CKD的患者（分别为555例和908例患者）之间的主要不良心血管事件（MACE，定义为全因死亡、心肌梗死和靶病变血运重建、心源性死亡以及支架血栓形成的复合事件）。结果显示，与非CKD组相比，CKD组发生MACE（对数秩检验p = 0.015）、全因死亡（对数秩检验p <0.001）和心源性死亡（对数秩检验p <0.001）的风险更高。多变量分析表明，CKD是MACE的独立预测因素（风险比1.23，95%置信区间1.02至1.47，p = 0.03）。在药物治疗方面，CKD组使用他汀类药物与MACE发生率显著降低相关（对数秩检验p = 0.003）。总之，CKD的存在是接受CTO-PCI治疗患者长期临床结局的重要预测因素，使用他汀类药物可能有助于降低不良临床结局。
