Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.
Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland.
Ren Fail. 2020 Nov;42(1):881-889. doi: 10.1080/0886022X.2020.1810069.
Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes.
The aim of our study was to assess renal function impact on mortality among patients with ACS.
The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009-2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m, hemodialysis. Mean observation time was 2296 days.
Criteria were met by 2213 patients. CKD occurred in 24.1% ( = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567-5.721, < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029-4.463, = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056-4.959, = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481-3.424, < .001).
PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
在急性冠状动脉综合征（ACS）的情况下合并慢性肾脏病（CKD）会显著恶化预后。
我们的研究旨在评估 ACS 患者肾功能对死亡率的影响。
本研究基于 2009 年至 2015 年在比亚韦斯托克医科大学住院的 21985 名患者的记录。纳入标准为 ACS。排除标准为：入院 24 小时内死亡、估算肾小球滤过率（eGFR）<15ml/min/1.73m、血液透析。平均观察时间为 2296 天。
符合条件的患者有 2213 名。CKD 发生率为 24.1%（533 例），更常见于非 ST 段抬高型心肌梗死（NSTEMI）患者（26.2%（337 例）与 21.2%（196 例），= 0.006）。STEMI 患者发生对比剂后急性肾损伤（PC-AKI）的发生率更高（5 例（46%）与 4.1 例（53%），<0.001）。在研究期间，705 人死亡（31.9%），更多见于 NSTEMI 患者（33.2%（428 例）与 29.95%（277 例），<0.001）。然而，在发生 PC-AKI 的患者中，有 57.6%死亡。PC-AKI 的风险随着肌酐浓度的增加而增加（RR：2.990，95%CI：1.567-5.721，<0.001），发生糖尿病（RR：2.143，95%CI：1.029-4.463，= 0.042）和心房颤动（RR：2.289，95%CI：1.056-4.959，= 0.036）的风险也增加。术后肌酐浓度增加的死亡风险更大（RR：2.254，95%CI：1.481-3.424，<0.001）。
PC-AKI 是 ACS 患者的主要并发症，在 STEMI 中更常见，可能是经皮冠状动脉介入治疗（PCI）患者长期死亡率的预后标志物。应更加重视 PC-AKI 的预防和诊断，但不应因担心 PC-AKI 而延迟必要的 PCI。
