ST 段抬高型心肌梗死患者的 1 年死亡率：基于肌酐的方程估算肾小球滤过率的预后影响。

One-year mortality of patients with ST-Elevation myocardial infarction: Prognostic impact of creatinine-based equations to estimate glomerular filtration rate.

机构信息

Quebec Heart-Lung Institute, Quebec, Canada.

Department of Cardiology, Centre Hospitalier Régional la Citadelle, Liège, Belgium.

出版信息

PLoS One. 2018 Jul 6;13(7):e0199773. doi: 10.1371/journal.pone.0199773. eCollection 2018.

DOI:10.1371/journal.pone.0199773

PMID:29979700

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6034802/

Abstract

BACKGROUND

Renal dysfunction is associated with worse outcomes after primary percutaneous coronary intervention (PCI). However, whether glomerular filtration rate (GFR) estimated with various equations can equally predict outcomes after ST-Elevation Myocardial Infarction (STEMI) is still debated.

METHODS

We compared the clinical impact of 3 different creatinine-based equations (Cockcroft and Gault (CG), CKD-epidemiology (CKD-EPI) and Full Age Spectrum (FAS)) to predict 1-year mortality in STEMI patients.

RESULTS

Among 1755 consecutive STEMI patients who had undergone primary PCI included between 2006 and 2011, median estimated GFR was 79 (61;96) with the CG, 81 (65;95) with CKD-EPI and 75 (60;91) mL/min/1.73 m2 with FAS equation. Reduced GFR values were independently associated with 1-year mortality risk with the 3 equations. Receiver operating curves (ROC) of CG and FAS equations were significantly superior to the CKD-EPI equation, p = 0.03 and p = 0.01, respectively. Better prediction with FAS and CG equations was confirmed by net reclassification index.

CONCLUSIONS

Our results suggest that in STEMI patients who have undergone primary PCI, 1-year mortality is better predicted by CG or FAS equations compared to CKD-EPI.

摘要

背景

肾功能障碍与经皮冠状动脉介入治疗（PCI）后的不良结局相关。然而，各种方程估算的肾小球滤过率（GFR）是否能同样预测 ST 段抬高型心肌梗死（STEMI）后的结局仍存在争议。

方法

我们比较了 3 种不同基于肌酐的方程（Cockcroft 和 Gault（CG）、肾脏病饮食改良试验（CKD-EPI）和全年龄谱（FAS））对预测 STEMI 患者 1 年死亡率的临床影响。

结果

在 2006 年至 2011 年间接受直接 PCI 的 1755 例连续 STEMI 患者中，CG 方程估算的 GFR 中位数为 79（61；96），CKD-EPI 为 81（65；95），FAS 为 75（60；91）mL/min/1.73 m2。3 种方程中，较低的 GFR 值与 1 年死亡率风险独立相关。CG 和 FAS 方程的接收者操作特征曲线（ROC）明显优于 CKD-EPI 方程，p = 0.03 和 p = 0.01。FAS 和 CG 方程的净重新分类指数证实了更好的预测。