National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Cardiorenal Med. 2023;13(1):354-362. doi: 10.1159/000534252. Epub 2023 Oct 12.
Limited data are available on the long-term impact of mild renal dysfunction (estimated glomerular filtration rate [eGFR] 60-89 mL/min/1.73 m2) in patients with three-vessel coronary disease (3VD).
A total of 5,272 patients with 3VD undergoing revascularization were included and were categorized into 3 groups: normal renal function (eGFR ≥90 mL/min/1.73 m2, n = 2,352), mild renal dysfunction (eGFR 60-89, n = 2,501), and moderate renal dysfunction (eGFR 30-59, n = 419). Primary endpoint was all-cause death. Secondary endpoints included cardiac death and major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke.
During the median 7.6-year follow-up period, 555 (10.5%) deaths occurred. After multivariable adjustment, patients with mild and moderate renal dysfunction had significantly higher risks of all-cause death (adjusted hazard ratio [HR]: 1.36, 95% confidence interval [CI]: 1.07-1.70; adjusted HR: 2.06, 95% CI: 1.53-2.78, respectively) compared with patients with normal renal function. Patients after coronary artery bypass grafting (CABG) had a lower rate of all-cause death and MACCE than those undergoing percutaneous coronary intervention (PCI) in the normal and mild renal dysfunction group but not in the moderate renal dysfunction group. Results were similar after propensity score matching.
In patients with 3VD, even mild renal impairment was significantly associated with a higher risk of all-cause death. The superiority of CABG over PCI diminished in those with moderate renal dysfunction. Our study alerts clinicians to the early screening of mild renal impairment in patients with 3VD and provides real-world evidence on the optimal revascularization strategy in patients with renal impairment.
在患有三支血管病变（3VD）的患者中，关于轻度肾功能障碍（估算肾小球滤过率[eGFR]60-89mL/min/1.73m2）的长期影响的数据有限。
共纳入 5272 例接受血运重建的 3VD 患者，并将其分为 3 组：肾功能正常（eGFR≥90mL/min/1.73m2，n=2352）、轻度肾功能障碍（eGFR60-89，n=2501）和中度肾功能障碍（eGFR30-59，n=419）。主要终点为全因死亡。次要终点包括心脏死亡和主要不良心脏和脑血管事件（MACCE），即死亡、心肌梗死和中风的复合终点。
在中位 7.6 年的随访期间，有 555 例（10.5%）死亡。经过多变量调整后，轻度和中度肾功能障碍患者的全因死亡风险显著增加（调整后的危险比[HR]：1.36，95%置信区间[CI]：1.07-1.70；调整后的 HR：2.06，95% CI：1.53-2.78），与肾功能正常的患者相比。在正常和轻度肾功能障碍组中，冠状动脉旁路移植术（CABG）患者的全因死亡率和 MACCE 发生率低于经皮冠状动脉介入治疗（PCI）患者，但在中度肾功能障碍组中则不然。倾向评分匹配后的结果相似。
在患有 3VD 的患者中，即使是轻度肾功能损害也与全因死亡风险显著增加相关。CABG 相对于 PCI 的优势在中度肾功能障碍患者中减弱。我们的研究提醒临床医生早期筛查 3VD 患者的轻度肾功能损害，并为肾功能损害患者提供最佳血运重建策略的真实世界证据。
