肾功能轨迹对伴肾功能障碍的 ST 段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的预后影响：一项十年所有患者登记研究的分析。

Prognostic impact of renal function trajectories in patients with STEMI and kidney dysfunction undergoing primary percutaneous coronary intervention: An analysis of ten years all-comers registry.

机构信息

Cardiology Service, Complejo Hospitalario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain.

出版信息

Hellenic J Cardiol. 2022 Jul-Aug;66:1-10. doi: 10.1016/j.hjc.2022.04.007. Epub 2022 May 2.

DOI:10.1016/j.hjc.2022.04.007

PMID:35513299

Abstract

BACKGROUND

Renal dysfunction in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) indicates a poor long-term prognosis. However, the prognostic value of the improvement or stabilisation of renal function during follow-up has not yet been assessed. This study aimed to investigate the long-term predictive impact of the improvement or stabilisation of renal function after one year of follow-up in patients with STEMI undergoing pPCI with renal dysfunction at discharge.

METHODS

This prospective, single-centre cohort study included 2170 consecutive patients with STEMI who underwent pPCI. The glomerular filtration rate (GFR) was determined at hospital discharge and one-year follow-up. The median clinical follow-up was 72 months.

RESULTS

Among the 2004 patients, 393 (19.6%) had a GFR <60 ml/min, and 1611 (80.4%) had a GFR ≥ 60 ml/min at discharge. Among patients with GFR <60 ml/min, data at one-year follow-up were available for 342. Of these patients, 127 (32%) showed improvement in renal function (defined as improvement in the Kidney Disease Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification), 47 (12%) showed worsening of renal function (defined as worsening of the KDIGO CKD classification), and 168 (43%) showed no category changes. Improvement or stabilisation of GFR at one year of follow-up was associated with a reduction of major adverse cardiovascular events (MACE) [HR 0.51, 95% CI: 0.35-0.75, p = 0.001] and all-cause mortality [HR 0.54, 95% CI: 0.34-0.84, p = 0.007] during follow-up.

CONCLUSIONS

The improvement or stabilisation of renal function at one-year follow-up in patients with STEMI and renal dysfunction is associated with a better long-term prognosis.

摘要

背景

行直接经皮冠状动脉介入治疗（pPCI）的 ST 段抬高型心肌梗死（STEMI）患者发生肾功能障碍提示预后不良。然而，在随访期间肾功能改善或稳定的预后价值尚未得到评估。本研究旨在探讨在 pPCI 后一年随访期间肾功能改善或稳定的 STEMI 合并肾功能障碍患者的长期预测影响。

方法

这是一项前瞻性、单中心队列研究，纳入了 2170 例连续 STEMI 患者行 pPCI。在出院和随访 1 年时确定肾小球滤过率（GFR）。中位临床随访时间为 72 个月。

结果

在 2004 例患者中，393 例（19.6%）的 GFR<60 ml/min，1611 例（80.4%）的 GFR 在出院时≥60 ml/min。在 GFR<60 ml/min 的患者中，1 年随访的数据可用于 342 例患者。这些患者中，127 例（32%）肾功能改善（定义为肾脏病改善全球结局（KDIGO）慢性肾脏病（CKD）分类改善），47 例（12%）肾功能恶化（定义为 KDIGO CKD 分类恶化），168 例（43%）无类别变化。1 年随访时 GFR 改善或稳定与主要不良心血管事件（MACE）减少相关[HR 0.51，95%CI：0.35-0.75，p=0.001]和全因死亡率[HR 0.54，95%CI：0.34-0.84，p=0.007]。