Ma Yu, Zha Lei, Zhang Qi, Cao Lu, Zhao Ru, Ma Jing, Hou Kai, Pan Yue, Cong Hongliang, Li Ximing
Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China.
Tianjin Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin 300222, China.
Cardiol Res Pract. 2022 Aug 23;2022:1638209. doi: 10.1155/2022/1638209. eCollection 2022.
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to inhibit pyroptosis and apoptosis, which play important roles in the development and progression of contrast-induced acute kidney injury (CI-AKI). However, to the best of our knowledge, no studies have investigated the potential effect of PCSK9 inhibitors on the prevalence of CI-AKI after percutaneous coronary intervention (PCI). This study aimed to determine whether PCSK9 inhibitors are associated with the prevalence of CI-AKI. The medical records of 309 (mean age, 63.35 years; 71.84% male) patients with acute myocardial infarction who underwent PCI at our institution were retrospectively analyzed. Overall, 149 and 160 patients were assigned to the evolocumab and control groups, respectively. Serum creatinine levels were examined preoperatively and 24-72 h postoperatively and compared between groups. Data were grouped according to the occurrence of CI-AKI, and a univariate analysis was conducted to exclude suspected influencing factors that led to CI-AKI occurrence. After adjusting for confounding factors, a logistic regression analysis was performed to assess the association between evolocumab administration (independent variable) and CI-AKI occurrence (dependent variable). The prevalence of CI-AKI was significantly lower in the evolocumab group (6.7%) than in the control group (20.0%; < 0.01).We further evaluated the correlation between exposure factor and outcome. The relative risk(RR) between the use of evolocumab and the occurrence of CI-AKI was 0.34(95% CI 0.17-0.66,p<0.01).This result indicate a significant association between the use of evolocumab and a reduction in the incidence of CI-AKI.The logistic regression analysis results revealed that evolocumab was significantly associated with CI-AKI. The use of PCSK9 inhibitors, hydration therapy, and statin administration appears promising for preventing CI-AKI in patients with acute myocardial infarction undergoing PCI.
前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂已被证明可抑制细胞焦亡和凋亡，而细胞焦亡和凋亡在造影剂诱导的急性肾损伤（CI-AKI）的发生和发展中起重要作用。然而，据我们所知，尚无研究探讨PCSK9抑制剂对经皮冠状动脉介入治疗（PCI）后CI-AKI发生率的潜在影响。本研究旨在确定PCSK9抑制剂是否与CI-AKI的发生率相关。我们对在我院接受PCI的309例急性心肌梗死患者（平均年龄63.35岁；71.84%为男性）的病历进行了回顾性分析。总体而言，149例和160例患者分别被分配至依洛尤单抗组和对照组。术前及术后24 - 72小时检测血清肌酐水平，并在组间进行比较。根据CI-AKI的发生情况对数据进行分组，并进行单因素分析以排除导致CI-AKI发生的可疑影响因素。在调整混杂因素后，进行逻辑回归分析以评估依洛尤单抗给药（自变量）与CI-AKI发生（因变量）之间的关联。依洛尤单抗组CI-AKI的发生率（6.7%）显著低于对照组（20.0%；P<0.01）。我们进一步评估了暴露因素与结局之间的相关性。使用依洛尤单抗与CI-AKI发生之间的相对风险（RR）为0.34（95%CI 0.17 - 0.66，P<0.01）。该结果表明使用依洛尤单抗与CI-AKI发生率降低之间存在显著关联。逻辑回归分析结果显示依洛尤单抗与CI-AKI显著相关。对于接受PCI的急性心肌梗死患者，使用PCSK9抑制剂、水化治疗和他汀类药物给药在预防CI-AKI方面似乎很有前景。
