慢性肾脏病对糖尿病患者经皮冠状动脉介入治疗结局的影响：系统评价和荟萃分析。

Impact of Chronic Kidney Disease on Outcomes of Percutaneous Coronary Intervention in Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis.

机构信息

Nephrology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China.

Endocrinology Department, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang Province, People's Republic of China.

出版信息

Tex Heart Inst J. 2023 Jan 1;50(1). doi: 10.14503/THIJ-22-7873.

DOI:10.14503/THIJ-22-7873

PMID:36753753

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9969770/

Abstract

BACKGROUND

The impact of chronic kidney disease (CKD) on adverse cardiovascular outcomes after percutaneous coronary intervention in patients with diabetes mellitus (DM) is still unclear. This study aimed to systematically assess evidence on this topic.

METHODS

The PubMed, Embase, and CENTRAL databases were searched for studies comparing mortality, myocardial infarction (MI), or revascularization outcomes between patients with DM with and without CKD.

RESULTS

In 11 studies, the presence of CKD was associated with significantly increased risk of early all-cause mortality (risk ratio [RR], 3.45; 95% CI, 3.07-3.87; I2 = 0%; P < .001), late all-cause mortality (RR, 2.78; 95% CI, 1.92-4.02; I2 = 83%; P < .001), cardiac mortality (RR, 2.90; 95% CI, 1.99-4.22; I2 = 29%; P < .001), and MI (RR, 1.40; 95% CI, 1.06-1.85; I2 = 13%; P = .02) compared with no CKD. There was no difference in the risk of any revascularization between those with and without CKD. Analysis of adjusted hazard ratios (HRs) indicated significantly increased risk of mortality (HR, 2.64; 95% CI, 1.91-3.64; I2 = 0%; P < .001) in the CKD group but only a nonsignificant tendency of increased MI (HR, 1.59; 95% CI, 0.99-2.54; I2 = 0%; P = .05) and revascularization (HR, 1.24; 95% CI, 0.94-1.63; I2 = 2%; P = .12) in the CKD group.

CONCLUSION

The presence of CKD in patients with DM significantly increases the risk of mortality and MI. However, CKD had no impact on revascularization rates.

摘要

背景

慢性肾脏病（CKD）对合并糖尿病（DM）的经皮冠状动脉介入治疗（PCI）患者不良心血管结局的影响仍不清楚。本研究旨在系统评估这一主题的证据。

方法

检索 PubMed、Embase 和 CENTRAL 数据库，以比较 CKD 患者和无 CKD 患者之间的死亡率、心肌梗死（MI）或血运重建结局。

结果

在 11 项研究中，CKD 的存在与早期全因死亡率（风险比 [RR]，3.45；95%CI，3.07-3.87；I2 = 0%；P <.001）、晚期全因死亡率（RR，2.78；95%CI，1.92-4.02；I2 = 83%；P <.001）、心源性死亡率（RR，2.90；95%CI，1.99-4.22；I2 = 29%；P <.001）和 MI（RR，1.40；95%CI，1.06-1.85；I2 = 13%；P =.02）显著增加相关。CKD 患者与无 CKD 患者的任何血运重建风险无差异。调整后的危险比（HRs）分析表明，CKD 组的死亡率风险显著增加（HR，2.64；95%CI，1.91-3.64；I2 = 0%；P <.001），但 CKD 组 MI（HR，1.59；95%CI，0.99-2.54；I2 = 0%；P =.05）和血运重建（HR，1.24；95%CI，0.94-1.63；I2 = 2%；P =.12）的趋势增加无统计学意义。