慢性完全闭塞经皮冠状动脉介入治疗患者的住院期间结局：系统评价和荟萃分析。
In-hospital outcomes of patients with chronic kidney disease undergoing percutaneous coronary intervention for chronic total occlusion: a systematic review and meta-analysis.
机构信息
Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan.
Division Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York.
出版信息
Coron Artery Dis. 2021 Dec 1;32(8):681-688. doi: 10.1097/MCA.0000000000001026.
BACKGROUND
The relative safety and efficacy of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in patients with chronic kidney disease (CKD) have not been well defined. We performed a systematic review and meta-analysis of observational studies to assess in-hospital outcomes in this population.
METHODS
We searched MEDLINE, EMBASE, and Cochrane Library databases from inception to April 2020 for all clinical trials and observational studies. Five observational studies with a total of 6769 patients met our inclusion criteria. Patients were divided into two groups based on estimated glomerular filtration rate (eGFR <60 ml/min/1.73m2 in CKD group and ≥ 60 ml/min/1.73m2 in non-CKD group). The primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury, coronary injury (perforation, dissection or tamponade), stroke and procedural success. Mantel-Haenszel random-effects model was used to calculate the odds ratio (OR) and 95% confidence intervals (CI).
RESULTS
In-hospital mortality was significantly higher among patients with CKD undergoing PCI for CTO (OR: 5.16, 95% CI: 2.60-10.26, P < 0.00001). Acute kidney injury (OR: 2.54, 95% CI: 1.89-3.40, P < 0.00001) and major bleeding (OR: 2.58, 95% CI: 1.20-5.54, P < 0.01) were also more common in the CKD group. No significant difference was observed in the occurrence of stroke (OR: 2.36, 95% CI: 0.74-7.54, P < 0.15) or coronary injury (OR: 1.38, 95% CI: 0.98-1.93, P < 0.06) between the two groups. Non-CKD patients had a higher likelihood of procedural success compared to CKD patients (OR: 0.66, 95% CI: 0.57-0.77, P < 0.00001).
CONCLUSION
Patients with CKD undergoing PCI for CTO have a significantly higher risk of in-hospital mortality, acute kidney injury and major bleeding when compared to non-CKD patients. They also have a lower procedural success rate.
背景
经皮冠状动脉介入治疗（PCI）治疗慢性肾脏病（CKD）患者慢性完全闭塞（CTO）的相对安全性和疗效尚未明确。我们对观察性研究进行了系统评价和荟萃分析，以评估该人群的住院结局。
方法
我们从 MEDLINE、EMBASE 和 Cochrane 图书馆数据库中检索了从成立到 2020 年 4 月的所有临床试验和观察性研究。共有 5 项观察性研究，总计 6769 例患者符合纳入标准。根据估计肾小球滤过率（CKD 组 eGFR<60ml/min/1.73m2，非 CKD 组 eGFR≥60ml/min/1.73m2）将患者分为两组。主要结局为住院死亡率。次要结局为急性肾损伤、冠状动脉损伤（穿孔、夹层或填塞）、卒中和手术成功率。采用 Mantel-Haenszel 随机效应模型计算比值比（OR）和 95%置信区间（CI）。
结果
CKD 患者行 CTO-PCI 后住院死亡率显著升高（OR：5.16，95%CI：2.60-10.26，P<0.00001）。CKD 组急性肾损伤（OR：2.54，95%CI：1.89-3.40，P<0.00001）和主要出血（OR：2.58，95%CI：1.20-5.54，P<0.01）也更为常见。两组间卒中（OR：2.36，95%CI：0.74-7.54，P<0.15）或冠状动脉损伤（OR：1.38，95%CI：0.98-1.93，P<0.06）的发生率无显著差异。与 CKD 患者相比，非 CKD 患者手术成功率更高（OR：0.66，95%CI：0.57-0.77，P<0.00001）。
结论
与非 CKD 患者相比，CKD 患者行 CTO-PCI 的住院死亡率、急性肾损伤和主要出血风险显著升高，手术成功率也较低。
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