时间就是肾脏：直接经皮冠状动脉介入治疗的 ST 段抬高患者的疼痛至球囊扩张时间与急性肾损伤的关系。
Time Is Kidney: Relation between Pain-to-Balloon Time and Acute Kidney Injury among ST Segment Elevation Patients Undergoing Primary Percutaneous Intervention.
机构信息
Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
Cardiorenal Med. 2022;12(2):55-60. doi: 10.1159/000523829. Epub 2022 Mar 4.
BACKGROUND
Among ST segment elevation myocardial infarction (STEMI), early hemodynamic changes may result in acute kidney injury (AKI) even prior to primary percutaneous coronary intervention (PCI); however, no information to date is present regarding the association between pain-to-balloon time (PBT) and AKI. We evaluated whether PBT predicts the risk of AKI among STEMI patients undergoing primary PCI.
METHODS
Medical records of 2,343 STEMI patients undergoing primary PCI were reviewed. Patients were stratified by PBT into 3 groups: ≤120, 121-360, and >360 min. Patients' records were assessed for the occurrence of AKI (defined by the KDIGO criteria as serum creatinine (sCr) elevation ≥0.3 mg/dL within 72 h after admission).
RESULTS
Mean age was 61 ± 13 years, and 1,919 (82%) were male. Patients having longer PBT had more AKI complicating the course of STEMI (7% vs. 8% vs. 13%, p < 0.001) and had significantly higher sCr changes throughout hospitalization (0.08 mg/dL vs. 0.11 mg/dL vs. 0.17 mg/dL p < 0.001). In a multivariable logistic regression model, each 1-h increase in PBT was independently associated with a 2.2% increase in risk for AKI (odds ratio 1.022, 95% confidence interval: 1.01-1.04, p = 0.02).
CONCLUSION
Longer PBT may be an independent marker for the development of AKI in STEMI patients undergoing primary.
背景
在 ST 段抬高型心肌梗死（STEMI）中，即使在进行直接经皮冠状动脉介入治疗（PCI）之前，早期血液动力学变化也可能导致急性肾损伤（AKI）；然而，目前尚无关于疼痛至球囊时间（PBT）与 AKI 之间关系的信息。我们评估了在接受直接 PCI 的 STEMI 患者中，PBT 是否可预测 AKI 的风险。
方法
回顾了 2343 例接受直接 PCI 的 STEMI 患者的病历。根据 PBT 将患者分为 3 组：≤120 分钟、121-360 分钟和>360 分钟。评估患者记录中 AKI 的发生情况（根据 KDIGO 标准定义为入院后 72 小时内血清肌酐（sCr）升高≥0.3mg/dL）。
结果
平均年龄为 61±13 岁，1919 例（82%）为男性。PBT 较长的患者发生 STEMI 过程中并发 AKI 的比例更高（7% vs. 8% vs. 13%，p<0.001），并且整个住院期间 sCr 变化显著更大（0.08mg/dL vs. 0.11mg/dL vs. 0.17mg/dL，p<0.001）。在多变量逻辑回归模型中，PBT 每增加 1 小时，AKI 的风险增加 2.2%（比值比 1.022，95%置信区间：1.01-1.04，p=0.02）。
结论
在接受直接 PCI 的 STEMI 患者中，较长的 PBT 可能是 AKI 发展的独立标志物。
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