Sattar Saadia, Hussain Sajid, Aijaz Saba, Khan Ghufran, Akhter Zohaib, Malik Rehan, Ali Imran, Pathan Asad
Department of Clinical Research, Tabba Heart Institute, Karachi, Pakistan.
Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan.
J Pak Med Assoc. 2020 Nov;70(11):1901-1907. doi: 10.5455/JPMA.22790.
To assess early and late outcome in severe chronic kidney disease patients undergoing revascularisation.
The retrospective ambi-directional cohort study was conducted at Tabba Heart Institute, Karachi, and comprised data from May, 2012, to July,2016, related to severe chronic kidney disease patients with creatinine clearance <30ml/min or end-stage renal disease on haemodialysis who had undergone coronary artery bypass graft / percutaneous coronary intervention. Early outcome was in-hospital major adverse cardiac event, like mortality, stroke and new haemodialysis. Late outcome was major adverse cardiac event, like mortality, stroke, re infarction and re-revascularisation. Data was analysed using Stata 12.1.
Of the 228 patients with mean age of 64.2±10.8 years, 109(47.8%) with a maen age of 65.4±11.6 had undergone percutaneous coronary intervention, and 119(52.2%) with a mean age of 64.2±10.8 years had undergone coronary artery bypass graft. Overall mortality was 36(15.8%) patients; 15(13.7%) percutaneous coronary intervention, 21(17.6%)coronary artery bypass graft (p>0.05). Predictors of in-hospital adverse events were coronary artery bypass graft and cardiogenic shock (p<0.05). Follow-up was available in 181(94.3%) patients with a mean duration of 22.0±13.9 months. Heart failure and post-procedure stroke were independent predictors of late outcome (p<0.05).
Among patients with severe chronic kidney disease or end stage renal disease undergoing revascularisation, percutaneous coronary intervention PCI was performed in patients with less complex anatomy or as emergency for acute ST-elevation myocardial infarction. Coronary artery bypass graft patients had higher early mortality, but improved late survival.
评估接受血运重建的重度慢性肾脏病患者的早期和晚期结局。
这项回顾性双向队列研究在卡拉奇的塔巴心脏研究所进行，纳入了2012年5月至2016年7月期间，肌酐清除率<30ml/分钟的重度慢性肾脏病患者或接受血液透析的终末期肾病患者，这些患者均接受了冠状动脉搭桥术/经皮冠状动脉介入治疗。早期结局为住院期间主要不良心脏事件，如死亡率、中风和新的血液透析。晚期结局为主要不良心脏事件，如死亡率、中风、再梗死和再次血运重建。使用Stata 12.1对数据进行分析。
228例平均年龄为64.2±10.8岁的患者中，109例（47.8%）平均年龄为65.4±11.6岁的患者接受了经皮冠状动脉介入治疗，119例（52.2%）平均年龄为64.2±10.8岁的患者接受了冠状动脉搭桥术。总体死亡率为36例（15.8%）患者；经皮冠状动脉介入治疗组为15例（13.7%），冠状动脉搭桥术组为21例（17.6%）（p>0.05）。住院不良事件的预测因素为冠状动脉搭桥术和心源性休克（p<0.05）。181例（94.3%）患者获得随访，平均随访时间为22.0±13.9个月。心力衰竭和术后中风是晚期结局的独立预测因素（p<0.05）。
在接受血运重建的重度慢性肾脏病或终末期肾病患者中，解剖结构不太复杂的患者或作为急性ST段抬高型心肌梗死的急诊患者接受了经皮冠状动脉介入治疗（PCI）。冠状动脉搭桥术患者早期死亡率较高，但晚期生存率有所改善。
