Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Heart Vessels. 2021 Sep;36(9):1275-1282. doi: 10.1007/s00380-021-01815-0. Epub 2021 Mar 6.
Hemodialysis (HD) patients tend to have sarcopenia and malnutrition, and both conditions are related to poor prognosis in the cardiovascular disease that often accompanies HD. However, the impact of sarcopenia or malnutrition on the long-term prognosis of HD patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains unclear. We analyzed 1,605 consecutive patients with ACS who had undergone PCI at a single center between January 2009 and December 2014. We evaluated all-cause mortality and prognosis-associated factors, including sarcopenia/malnutrition-related factors such as the Geriatric Nutritional Risk Index (GNRI), and Skeletal Muscle Mass Index (SMI). After exclusions, 1461 patients were enrolled, and 58 (4.0%) were on HD. The HD group had lower levels of SMI and GNRI than non-HD group, and had worse in-hospital prognosis. Moreover, HD group had a significant higher mortality in the long-term follow-up [median follow-up period: 1219 days; Hazard Ratio (HR) = 4.09, p < 0.001]. After adjusting the covariates, SMI and GNRI were the factors associated with all-cause mortality in all patients [SMI: adjusted HR (aHR) = 2.39, p = 0.036; GNRI: aHR = 2.21, p = 0.006]; however, these findings were not observed among HD patients with ACS, and only diabetes was significantly associated with all-cause mortality (diabetes: aHR = 3.50, p = 0.031). HD patients with ACS had a significantly higher rate of in-hospital and long-term mortality than non-HD patients. Although sarcopenia and malnutrition were related to mortality and were more common in HD patients, sarcopenia and malnutrition had a lower impact than diabetes on the long-term prognosis of HD patients with ACS.
血液透析（HD）患者往往存在肌肉减少症和营养不良，这两种情况都与 HD 患者常伴发的心血管疾病不良预后有关。然而，对于接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）的 HD 患者，肌肉减少症或营养不良对其长期预后的影响尚不清楚。我们分析了 2009 年 1 月至 2014 年 12 月在单中心接受 PCI 的 1605 例连续 ACS 患者。我们评估了全因死亡率和预后相关因素，包括与肌肉减少症/营养不良相关的因素，如老年营养风险指数（GNRI）和骨骼肌质量指数（SMI）。排除后，共有 1461 例患者被纳入研究，其中 58 例（4.0%）正在接受 HD 治疗。HD 组的 SMI 和 GNRI 水平低于非 HD 组，且住院期间预后较差。此外，HD 组在长期随访中死亡率显著较高[中位随访时间：1219 天；风险比（HR）=4.09，p<0.001]。调整混杂因素后，SMI 和 GNRI 是所有患者全因死亡的相关因素[SMI：调整 HR（aHR）=2.39，p=0.036；GNRI：aHR=2.21，p=0.006]；然而，这些发现并未在 ACS 的 HD 患者中观察到，只有糖尿病与全因死亡率显著相关（糖尿病：aHR=3.50，p=0.031）。ACS 的 HD 患者的住院和长期死亡率明显高于非 HD 患者。尽管肌肉减少症和营养不良与死亡率相关，且在 HD 患者中更为常见，但与糖尿病相比，肌肉减少症和营养不良对 ACS 的 HD 患者的长期预后影响较低。
