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预测慢性冠状动脉综合征患者急性肾损伤风险评分与晚期肾损伤的相关性。

Predictivity of acute kidney injury risk scores for late kidney injury in patients with chronic coronary syndrome.

机构信息

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.

Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan.

出版信息

Heart Vessels. 2022 Dec;37(12):1971-1976. doi: 10.1007/s00380-022-02105-z. Epub 2022 May 30.

Abstract

Late rather than acute kidney injury after percutaneous coronary intervention (PCI) has been recently recognized as a predictor of future adverse events in patient with coronary artery disease. The risk-predicting models for acute kidney injury reported by Mehran et al., Bartholomew et al., and Tsai et al. were derived from a large cohort and externally validated, although the applicability of these models for predicting late kidney injury is unknown. A total of 327 patients undergoing elective PCI procedures were included. We calculated the three scores and tested their diagnostic ability for predicting late kidney injury (> 6 months after PCI), defined as an increase in creatinine levels ≥ 0.3 mg/dl or ≥ 50% from baseline. During the median follow-up period of 28 months, 27 (8.3%) patients had late kidney injury. All three scores significantly predicted late kidney injury, among which the score by Tsai et al. had a better diagnostic ability (area under the curve 0.83, best cut-off value 14, p < 0.001). With the best cut-off value, patients with Tsai score ≥ 14 had a significantly higher rate of late kidney injury than their counterpart (27.4% vs. 2.8%, p < 0.001). In conclusion, established risk scores for acute kidney injury may be useful for predicting late kidney injury after PCI in patients with chronic coronary syndrome.

摘要

经皮冠状动脉介入治疗(PCI)后迟发性而非急性肾损伤最近被认为是冠心病患者未来不良事件的预测因素。Mehran 等人、Bartholomew 等人和 Tsai 等人报告的急性肾损伤风险预测模型是从大型队列中推导出来并经过外部验证的,尽管这些模型预测迟发性肾损伤的适用性尚不清楚。共纳入 327 例行择期 PCI 手术的患者。我们计算了这三个评分,并测试了它们预测迟发性肾损伤(PCI 后>6 个月)的诊断能力,定义为肌酐水平升高≥0.3mg/dl 或比基线升高≥50%。在 28 个月的中位随访期间,27 名(8.3%)患者发生迟发性肾损伤。所有三个评分均显著预测迟发性肾损伤,其中 Tsai 评分的诊断能力更好(曲线下面积 0.83,最佳截断值 14,p<0.001)。在最佳截断值下,Tsai 评分≥14 的患者迟发性肾损伤发生率明显高于评分较低的患者(27.4% vs. 2.8%,p<0.001)。总之,急性肾损伤的既定风险评分可能有助于预测慢性冠状动脉综合征患者 PCI 后迟发性肾损伤。

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