Department of Cardiology, Dongguan TCM Hospital, Dongguan 523000, China.
The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang 523808, China.
J Interv Cardiol. 2021 Mar 8;2021:6641887. doi: 10.1155/2021/6641887. eCollection 2021.
Contrast-associated acute kidney injury (CA-AKI) is a common complication in patients undergoing coronary angiography (CAG). However, few studies demonstrate the association between the prognosis and developed CA-AKI in the different periods after the operation.
We retrospectively enrolled 3206 patients with preoperative serum creatinine (Scr) and at least twice SCr measurement after CAG. CA-AKI was defined as an increase ≥50% or ≥0.3 mg/dL from baseline in the 72 hours after the procedure. Early CA-AKI was defined as having the first increase in SCr within the early phase (<24 hours), and late CA-AKI was defined as an increase in SCr that occurred for the first time in the late phase (24-72 hours). The first endpoint of this study was long-term all-cause mortality. Kaplan-Meier analysis was used to count the cumulative mortality, and the log-rank test was used to assess differences between curves. Univariate and multivariate cox regression analyses were performed to assess whether patients who developed different type CA-AKI were at increased risk of long-term mortality.
The number of deaths in the 3 groups was 407 for normal (12.7%), 106 for early CA-AKI (32.7%) and 57 for late CA-AKI (17.7%), during a median follow-up period of 3.95 years. After adjusting for important clinical variables, early CA-AKI (HR = 1.33, 95% CI: 1.02-1.74, =0.038) was significantly associated with mortality, while late CA-AKI (HR = 0.92, 95% CI: 0.65-1.31, =0.633) was not. The same results were found in patients with coronary artery disease, chronic kidney disease, diabetes mellitus, and percutaneous coronary intervention.
Early increases in Scr, i.e., early CA-AKI, have better predictive value for long-term mortality. Therefore, in clinical practice, physicians should pay more attention to patients with early renal injury related to long-term prognosis and give active treatment.
对比剂相关急性肾损伤（CA-AKI）是接受冠状动脉造影（CAG）的患者常见的并发症。然而，很少有研究表明手术不同时期发生的 CA-AKI 与预后之间的关系。
我们回顾性纳入了 3206 例术前血清肌酐（Scr）和 CAG 后至少两次 Scr 测量值的患者。CA-AKI 定义为术后 72 小时内 Scr 较基线升高≥50%或≥0.3mg/dL。早期 CA-AKI 定义为早期（<24 小时）首次出现 Scr 首次升高，晚期 CA-AKI 定义为晚期（24-72 小时）首次出现 Scr 升高。本研究的首要终点是长期全因死亡率。Kaplan-Meier 分析用于计算累积死亡率，对数秩检验用于评估曲线之间的差异。进行单变量和多变量 Cox 回归分析，以评估发生不同类型 CA-AKI 的患者是否有更高的长期死亡风险。
3 组的死亡人数分别为正常组（12.7%）407 例，早期 CA-AKI 组（32.7%）106 例，晚期 CA-AKI 组（17.7%）57 例，中位随访时间为 3.95 年。在校正重要的临床变量后，早期 CA-AKI（HR=1.33，95%CI：1.02-1.74，=0.038）与死亡率显著相关，而晚期 CA-AKI（HR=0.92，95%CI：0.65-1.31，=0.633）则没有。在患有冠心病、慢性肾脏病、糖尿病和经皮冠状动脉介入治疗的患者中也得到了相同的结果。
Scr 的早期升高，即早期 CA-AKI，对长期死亡率具有更好的预测价值。因此，在临床实践中，医生应更加关注与长期预后相关的早期肾损伤患者，并给予积极治疗。
