Sun Guoli, Chen Pengyuan, Wang Kun, Li Hualong, Chen Shiqun, Liu Jin, He Yibo, Song Feier, Liu Yong, Chen Ji-Yan
1 Guangdong General Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
2 Department of Cardiology, Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Angiology. 2019 Aug;70(7):621-626. doi: 10.1177/0003319718803677. Epub 2018 Oct 15.
Abnormal hemodynamics is thought to contribute to the increased risk of contrast-induced nephropathy (CIN) and mortality. However, few studies focused on patients without abnormal hemodynamics (defined as hypotension, intra-aortic balloon pump usage) and reduced left ventricular ejection fraction (LVEF < 40%). Our study was to explore the impact of CIN on mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) with relative stable hemodynamics. In this observational study, we included 696 patients with AMI undergoing PCI without reduced LVEF and abnormal hemodynamics. The end point was long-term, all-cause mortality. During the mean follow-up of 2.79 years, CIN was detected in 110 (15.8%) patients. The total all-cause mortality was higher in CIN group than that in non-CIN group (24% vs 3.4%, < .001). In the multivariate Cox analysis, CIN was an independent predictor of worse outcomes (adjusted hazard ratio [HR]: 2.97, 95% confidence interval: 1.46-6.06, < .001) and significantly associated with long-term mortality, so did renal insufficiency (adjusted HR: 4.40, < .001) and use of β-blockers (adjusted HR: 0.33, < .001). Among patients with AMI, CIN independently predicted long-term mortality following PCI, regardless of LVEF impairment and abnormal hemodynamics.
异常血流动力学被认为会增加造影剂肾病（CIN）风险和死亡率。然而，很少有研究关注血流动力学无异常（定义为低血压、使用主动脉内球囊反搏）且左心室射血分数降低（LVEF<40%）的患者。我们的研究旨在探讨CIN对急性心肌梗死（AMI）患者行冠状动脉介入治疗（PCI）且血流动力学相对稳定时死亡率的影响。在这项观察性研究中，我们纳入了696例行PCI且LVEF未降低及血流动力学无异常的AMI患者。终点为长期全因死亡率。在平均2.79年的随访期间，110例（15.8%）患者检测到CIN。CIN组的全因总死亡率高于非CIN组（24%对3.4%，P<.001）。在多变量Cox分析中，CIN是预后较差的独立预测因素（校正风险比[HR]：2.97，95%置信区间：1.46 - 6.06，P<.001），并与长期死亡率显著相关，肾功能不全（校正HR：4.40，P<.001）和使用β受体阻滞剂（校正HR：0.33，P<.001）也是如此。在AMI患者中，无论LVEF受损和血流动力学异常情况如何，CIN均可独立预测PCI后的长期死亡率。
