血管通路对行冠状动脉造影和/或经皮冠状动脉介入治疗的患者对比剂肾病发展的影响。
Impact of vascular access on the development of contrast induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention.
机构信息
Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
出版信息
Int J Cardiol. 2019 Jan 15;275:48-52. doi: 10.1016/j.ijcard.2018.08.026. Epub 2018 Aug 10.
BACKGROUND
Contrast induced nephropathy (CIN) is a common complication of procedures that foresee the use of contrast media. Several risk factors have been identified as independent predictors of CIN, but, to date, no definitive data are available about the association between the angiographic approach and its development.
METHODS AND RESULTS
Our population included 4199 patients undergoing coronary angiography and/or PCI. CIN was defined as an absolute ≥0.5 mg/dl or a relative ≥25% increase in creatinine level at 24-48 h after the procedure without another clear cause for the acute kidney injury. The total incidence of CIN was 12.4%. We divided our population into two groups, according to the angiographic approach: transradial (TR) n = 1915 or transfemoral (TF) n = 2284. Patients treated with TR approach were more often males, with history of hypertension, and PCI, but less often diabetic, with previous myocardial infarction, coronary artery by-pass graft surgery and cerebrovascular accident. They had a higher ejection fraction, higher prevalence of PCI, elective indication but interestingly a lower amount of contrast volume. Patients treated with TR approach had higher platelets, Total, LDL and HDL cholesterol, but lower triglycerides, glycaemia and basal creatinine. No significant difference was observed between the two groups regarding the development of CIN (TR 13.2% vs TF 11.7%, p = 0.16). The absence of association between angiographic approach and the incidence of CIN was also confirmed at multivariate analysis after correction for baseline confounders (Adjusted OR [95% CI] = 1.2 [0.97-1.50], p = 0.09) and at subgroup analysis according to main risk factors for CIN. Similar results were obtained dividing our population according to propensity score tertiles: 1st Tertile CIN (TF 8.8% vs TR 8.9%), p = 0.95; OR (99% CI) = 1.01 (0.96-1.48), p = 0.95, 2nd Tertile CIN (TF 10.8% vs TR 12.4%), p = 0.35; OR (99% CI) = 1.17 (0.84-1.62), p = 0.35, and 3rd Tertile CIN (TF 15.6% vs TR 17.2%), p = 0.41; OR (99% CI) = 1.12 (0.85-1.48), p = 0.41.
CONCLUSION
This is the first large study showing the absence of relationship between the angiographic access and the incidence of CIN.
背景
对比剂肾病（CIN）是预见使用对比剂的程序的常见并发症。已经确定了几种风险因素作为 CIN 的独立预测因子，但迄今为止，尚无关于血管造影方法及其发展之间关联的明确数据。
方法和结果
我们的人群包括 4199 名接受冠状动脉造影和/或 PCI 的患者。CIN 的定义为在程序后 24-48 小时内肌酐水平绝对升高≥0.5mg/dl 或相对升高≥25%，且无急性肾损伤的其他明确原因。CIN 的总发生率为 12.4%。我们根据血管造影方法将人群分为两组：经桡动脉（TR）n=1915 或经股动脉（TF）n=2284。接受 TR 治疗的患者更常为男性，有高血压和 PCI 病史，但糖尿病、既往心肌梗死、冠状动脉旁路移植术和脑血管意外较少。他们的射血分数更高，接受 PCI 的比例更高，为选择性适应证，但有趣的是，他们的造影剂体积较低。接受 TR 治疗的患者血小板、总胆固醇、LDL 胆固醇和 HDL 胆固醇较高，但甘油三酯、血糖和基础肌酐较低。两组之间 CIN 的发生无显著差异（TR 13.2%vs TF 11.7%，p=0.16）。多变量分析校正基线混杂因素后（校正比值比[95%CI]1.2[0.97-1.50]，p=0.09）和根据 CIN 的主要危险因素进行亚组分析后，也证实了血管造影方法与 CIN 发生率之间无关联。根据倾向评分三分位数将人群进一步分组也得到了类似的结果：第 1 三分位数 CIN（TF 8.8%vs TR 8.9%），p=0.95；比值比（99%CI）1.01（0.96-1.48），p=0.95，第 2 三分位数 CIN（TF 10.8%vs TR 12.4%），p=0.35；比值比（99%CI）1.17（0.84-1.62），p=0.35，第 3 三分位数 CIN（TF 15.6%vs TR 17.2%），p=0.41；比值比（99%CI）1.12（0.85-1.48），p=0.41。
结论
这是第一项表明血管造影方法与 CIN 发生率之间无关联的大型研究。
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