慢性肾脏病经皮冠状动脉介入治疗患者的冠状动脉病变分布。
Coronary artery lesion distribution in patients with chronic kidney disease undergoing percutaneous coronary intervention.
机构信息
Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan.
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
出版信息
Ren Fail. 2022 Dec;44(1):1098-1103. doi: 10.1080/0886022X.2022.2093748.
PURPOSE
To determine the location of coronary atherosclerosis distribution observed in patients with chronic kidney disease (CKD).
METHODS
A cross-sectional study was conducted using the database of cardiovascular medicine data from Saitama Sekishinkai Hospital to clarify the association between renal function and angiographic characteristics of coronary atherosclerosis. In total, 3268 patients who underwent percutaneous coronary intervention were included. Propensity score matching revised the total to 1772. The association of renal function with the location and/or distribution of coronary atherosclerosis lesions was then examined.
RESULTS
Overall, coronary lesion was observed in the left anterior descending coronary artery (LAD) in 56% patients, whereas 28% and 22% were in the right coronary artery (RCA) and left circumflex coronary artery (LCX), respectively. LAD was most affected and observed in 57% patients with stage 1 CKD. RCA was second-most affected, at 26% CKD stage 1, but it increased to 31%, 38%, and 59% in CKD 3, 4, and 5, respectively. In CKD 5 patients, the RCA was the most affected artery (59%), with 41% LAD lesions. Logistic regression analysis after propensity score matching showed that the odds ratios for an RCA lesion was 3.658 in CKD 5 ( = .025) compared with CKD 1 after adjusting for traditional risk factors.
CONCLUSION
The prevalence of RCA lesions, but not LAD or LCX lesions, increased with increasing CKD stage. The pathophysiology of coronary atherosclerosis may differ by lesion location. Deterioration of renal function may affect progression of atherosclerosis more in the RCA than in the LAD or LCX.
目的
确定慢性肾脏病（CKD）患者冠状动脉粥样硬化分布的位置。
方法
本研究采用埼玉县塞基信会医院心血管医学数据库进行横断面研究，以明确肾功能与冠状动脉粥样硬化血管造影特征之间的关系。共纳入 3268 例行经皮冠状动脉介入治疗的患者。采用倾向评分匹配法将总例数修正为 1772 例。然后，检查肾功能与冠状动脉粥样硬化病变部位和/或分布的关系。
结果
总体而言，56%的患者存在左前降支（LAD）冠状动脉病变，28%和 22%分别存在右冠状动脉（RCA）和左旋支（LCX）病变。LAD 是受影响最严重的血管，在 1 期 CKD 患者中占 57%。RCA 次之，在 1 期 CKD 中占 26%，但在 3、4、5 期 CKD 中分别增加至 31%、38%和 59%。在 5 期 CKD 患者中，RCA 是受影响最严重的血管（59%），LAD 病变占 41%。在调整传统危险因素后，倾向评分匹配的 logistic 回归分析显示，与 1 期 CKD 相比，5 期 CKD 患者 RCA 病变的比值比为 3.658（P =.025）。
结论
随着 CKD 分期的增加，RCA 病变的发生率增加，而 LAD 或 LCX 病变的发生率无增加。冠状动脉粥样硬化的病理生理学可能因病变部位而异。肾功能恶化可能比 LAD 或 LCX 更易影响 RCA 动脉粥样硬化的进展。
Zotero 插件