Internal Medicine Residency, National University Health System.
Department of Cardiology, National University Heart Centre.
Coron Artery Dis. 2021 Sep 1;32(6):517-525. doi: 10.1097/MCA.0000000000000980.
The effects of chronic kidney disease (CKD) on outcomes in patients undergoing semi-urgent and elective percutaneous coronary intervention (PCI) are unclear. This study aims to investigate impact of CKD on long-term outcomes of this population.
This was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from 1 January 2014 to 31 December 2015 at a tertiary academic center. They were stratified into five groups - group 1 [estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73m2], group 2 (eGFR 60-89 ml/min/1.73m2), group 3 (eGFR 30-59 ml/min/1.73 m2), group 4 (eGFR <30 ml/min/1.73m2), and group 5 (dialysis). Demographics, risk factors in relation to endpoints of all-cause mortality, contrast-induced nephropathy (CIN), three-point major adverse cardiac events (MACE) (cardiac death, subsequent myocardial infarction, subsequent stroke), and four-point MACE (including target lesion revascularization) were analyzed.
One thousand six hundred nine patients were included. Advanced CKD patients were more likely to be female and older, with higher prevalence of co-morbidities. Compared to group 1, group 4 patients were associated with increased risk of three-point [adjusted hazard ratio (aHR) 1.94, 95% confidence interval (CI): 1.06-3.55; P = 0.031] and four-point MACE (aHR 2.15, 95% CI: 1.21-3.80; P = 0.009). However, higher contrast volume usage [odds ratio (OR) 2.20, 95% CI: 1.04-4.68; P = 0.040) was associated with increased CIN risk but not reduced eGFR (OR 1.62, 95% CI: 0.57-4.65; P = 0.369).
Advanced CKD patients undergoing PCI were associated with higher co-morbid burden. Despite adjustments for co-morbidities, these patients had higher mortality and worse cardiovascular outcomes at 3 years following contemporary PCI.
慢性肾脏病（CKD）对接受半紧急和择期经皮冠状动脉介入治疗（PCI）患者结局的影响尚不清楚。本研究旨在探讨 CKD 对该人群长期结局的影响。
这是一项回顾性队列研究，纳入了 2014 年 1 月 1 日至 2015 年 12 月 31 日在一家三级学术中心接受半紧急和择期 PCI 的患者。他们被分为五组：第 1 组[eGFR（肾小球滤过率）≥90ml/min/1.73m2]、第 2 组（eGFR 60-89ml/min/1.73m2）、第 3 组（eGFR 30-59ml/min/1.73m2）、第 4 组（eGFR<30ml/min/1.73m2）和第 5 组（透析）。分析了所有原因死亡率、对比剂诱导的肾病（CIN）、三点主要不良心脏事件（MACE）（心脏死亡、随后心肌梗死、随后中风）和四点 MACE（包括靶病变血运重建）终点的人口统计学、相关风险因素。
共纳入 1609 例患者。晚期 CKD 患者更可能为女性和老年人，合并症的发生率更高。与第 1 组相比，第 4 组患者三点 MACE（调整后危险比[aHR]1.94，95%置信区间[CI]：1.06-3.55；P=0.031）和四点 MACE（aHR 2.15，95%CI：1.21-3.80；P=0.009）风险增加。然而，更高的对比剂用量（比值比[OR]2.20，95%CI：1.04-4.68；P=0.040）与 CIN 风险增加相关，而与 eGFR 降低无关（OR 1.62，95%CI：0.57-4.65；P=0.369）。
接受 PCI 的晚期 CKD 患者合并症负担更重。尽管调整了合并症因素，但这些患者在接受当代 PCI 后 3 年的死亡率和心血管结局更差。
