Department of Cardiovascular Medicine Miyazaki Prefectural Nobeoka Hospital Miyazaki Japan.
Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan.
J Am Heart Assoc. 2019 Dec 3;8(23):e014096. doi: 10.1161/JAHA.119.014096. Epub 2019 Nov 26.
Background The long-term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast-induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver-operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (=0.001) and in those without CIN (<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30-10.8; <0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions Persistent RD, but not transient RD, is independently associated with long-term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.
患有持续性肾功能障碍（RD）的急性心肌梗死患者的长期预后尚不清楚。我们研究了经皮冠状动脉介入治疗（PCI）后发生对比剂诱导的肾病（CIN）的急性心肌梗死患者持续性 RD 的危险因素和预后意义。
我们纳入了 952 例连续接受经皮冠状动脉介入治疗的急性心肌梗死患者。CIN 的定义为 PCI 后 72 小时内血清肌酐水平升高≥0.5mg/dL 或基线值升高≥25%。持续性 RD 的定义为 CIN 后 2 周以上肾功能持续受损，而短暂性 RD 则定义为肾功能在 2 周内恢复。CIN 的总体发生率为 8.8%，持续性 CIN 的发生率为 3.1%。ROC 曲线显示，持续性 CIN 的对比剂体积/基线估计肾小球滤过率比值的最佳截断值为 3.45。多变量逻辑分析显示，对比剂体积/基线估计肾小球滤过率>3.45 是持续性 RD 的独立相关因素。在 3 年时，持续性 RD 患者的死亡率明显高于短暂性 RD 患者（=0.001）和无 CIN 患者（<0.001）。Cox 回归分析显示，持续性 RD（危险比，4.99；95%CI，2.30-10.8；<0.001）是死亡率的一个显著危险因素。死亡、血液透析、卒中和急性心肌梗死等联合终点也出现了类似的趋势。
持续性 RD 而不是短暂性 RD 与长期死亡率独立相关。对比剂体积/基线估计肾小球滤过率>3.45 是持续性 RD 的独立预测因素。
