Khoury Shafik, Margolis Gilad, Rozenbaum Zach, Rozenfeld Keren-Lee, Keren Gad, Shacham Yacov
Department of Cardiology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Coron Artery Dis. 2019 Dec;30(8):564-568. doi: 10.1097/MCA.0000000000000742.
Elderly individuals ( ≥ 75 years) constitute an increasing proportion of patients presenting with myocardial infarction treated with primary percutaneous coronary intervention (PCI), but only limited data are available regarding the incidence and prognostic implications of acute kidney injury (AKI) in this group of patients.
To evaluate the incidence and prognostic implications of AKI in older adults ( ≥ 75 years) with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI.
A retrospective cohort, observational, single-center study of consecutive 416 older patients with STEMI (≥ 75 years) treated with primary PCI between January 2008 and August 2017 was conducted. AKI was defined as an increase of at least 0.3 mg/dl in serum creatinine within 48 h following admission.
A total of 96/416 (23%) patients developed AKI. The occurrence of AKI was associated with adverse in-hospital outcomes, higher 30 days (25 vs. 6%; P < 0.001), and long-term mortality (46 vs. 17%; hazard ratio: 3.2; 95% confidence interval: 2.1-4.7; P < 0.001). Among patients with AKI, 46/96 (48%) demonstrated recovery of renal function at hospital discharge. Lack of renal function recovery at discharge (50/96 patients; 52%) was associated with the occurrence of new or progression of baseline chronic kidney disease.
Among older patients with STEMI undergoing primary PCI, AKI is a frequent complication associated with adverse renal short-term and long-term outcomes.
在接受直接经皮冠状动脉介入治疗（PCI）的心肌梗死患者中，老年患者（≥75岁）所占比例日益增加，但关于该组患者急性肾损伤（AKI）的发生率及其对预后的影响，现有数据有限。
评估接受直接PCI治疗的年龄≥75岁的ST段抬高型心肌梗死（STEMI）老年患者中AKI的发生率及其对预后的影响。
对2008年1月至2017年8月期间连续416例接受直接PCI治疗的年龄≥75岁的STEMI老年患者进行了一项回顾性队列观察性单中心研究。AKI定义为入院后48小时内血清肌酐至少升高0.3mg/dl。
共有96/416例（23%）患者发生AKI。AKI的发生与住院期间不良结局、30天较高死亡率（25%对6%；P<0.001）及长期死亡率（46%对17%；风险比：3.2；95%置信区间：2.1-4.7；P<0.001）相关。在发生AKI的患者中，46/96例（48%）在出院时肾功能恢复。出院时肾功能未恢复（50/96例患者；52%）与新发或基线慢性肾脏病进展相关。
在接受直接PCI治疗的老年STEMI患者中，AKI是一种常见并发症，与肾脏短期和长期不良结局相关。
