Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Division of Cardiovascular Diseases, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Clin Cardiol. 2022 Aug;45(8):882-891. doi: 10.1002/clc.23877. Epub 2022 Jun 27.
To determine the risk prediction of various degrees of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention (PCI).
Patients with chronic kidney disease (CKD) are at high risk of all-cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks.
This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m ): I (≥90), II (60-89), III (30-59), IV (15-29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One-year all-cause mortality was reported with risk prediction based on CKD stages and other risk factors.
Patients with CKD stage I-V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One-year overall survival among CKD stages I-V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log-rank test). After adjusting covariables, the hazard ratios of all-cause mortality for CKD stages II-V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001).
Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose-dependent effect with decreased 1-year survival. This finding may be useful for risk classification and to guide decision-making.
确定经皮冠状动脉介入治疗（PCI）后不同程度肾功能损害对全因死亡率的风险预测。
慢性肾脏病（CKD）患者 PCI 后全因死亡率较高。然而，关于不同程度肾功能损害预测这些风险的数据较少。
这是一项对 22045 例患者进行的全国性 PCI 登记研究的亚组分析。根据术前估算肾小球滤过率（eGFR）（ml/min/1.73 m）将患者分为六期 CKD：I（≥90）、II（60-89）、III（30-59）、IV（15-29）或 V（<15）期，不包括或包括透析。比较每个阶段患者的基线临床和血管造影特征。报告了基于 CKD 分期和其他危险因素的 1 年全因死亡率。
发现无透析和有透析的 CKD 分期 I-V 患者分别占 26.9%、40.8%、23.2%、3.9%、1.5%和 3.7%。PCI 手术成功率和并发症发生率分别为 94.0%至 96.2%和 2.8%至 6.1%。CKD 分期 I-V 的 1 年总生存率分别为 96.3%、93.1%、84.4%、65.2%、68.0%和 69.4%（对数秩检验，p<0.001）。在调整协变量后，多变量 Cox 回归分析显示，与 CKD 分期 I 相比，CKD 分期 II-V 的全因死亡率的风险比分别为 1.5、2.6、5.3、5.9 和 7.0（p<0.001）。
在接受 PCI 的患者中，术前 eGFR 越低，与 1 年生存率降低呈剂量依赖性相关。这一发现可能有助于风险分类，并指导决策。
