Lu Yucheng, Ni Weicheng, Qu Xiang, Chen Changxi, Shi Sanling, Guo Kun, Lin Ken, Zhou Hao
Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Angiology. 2024 Apr 28:33197241251889. doi: 10.1177/00033197241251889.
Patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) are at high risk of contrast-induced nephropathy (CIN), which can subsequently worsen the overall prognosis. To evaluate the efficacy of spironolactone for CIN prevention, 410 patients with AMI and CKD receiving percutaneous coronary intervention (PCI) were retrospectively analyzed. Among them, 240 and 170 patients were enrolled in the standard treatment and spironolactone groups (spironolactone was administered 2 days before and 3 days after PCI), respectively. The primary endpoint of CIN was defined as a 0.5 mg/dL or >25% increase from the baseline serum creatinine level within 48-72 h post-PCI. CIN incidence was significantly lower in the spironolactone group than in the standard treatment group (11.2 vs 26.7%, < .001). Further, cardiac re-hospitalization (hazard ratio [HR]: 0.515; 95% CI: 0.382-0.694; < .001) and cardiac death (HR: 0.612; 95% CI: 0.429-0.872; = .007) risks were significantly lower in patients who received long-term spironolactone with a median treatment duration of 42 months after discharge. Spironolactone might lower the risk of CIN, and long-term use of spironolactone reduces the risk of cardiac re-hospitalization and cardiac death in patients with AMI and CKD undergoing PCI.
急性心肌梗死（AMI）和慢性肾脏病（CKD）患者发生造影剂肾病（CIN）的风险很高，这会进一步恶化总体预后。为评估螺内酯预防CIN的疗效，对410例接受经皮冠状动脉介入治疗（PCI）的AMI和CKD患者进行了回顾性分析。其中，分别有240例和170例患者纳入标准治疗组和螺内酯组（PCI术前2天和术后3天给予螺内酯）。CIN的主要终点定义为PCI术后48 - 72小时内血清肌酐水平较基线升高0.5 mg/dL或升高>25%。螺内酯组的CIN发生率显著低于标准治疗组（11.2%对26.7%，P<0.001）。此外，出院后接受中位治疗时间为42个月的长期螺内酯治疗的患者，心脏再住院风险（风险比[HR]：0.515；95%置信区间：0.382 - 0.694；P<0.001）和心源性死亡风险（HR：0.612；95%置信区间：0.429 - 0.872；P = 0.007）显著更低。螺内酯可能会降低CIN风险，长期使用螺内酯可降低接受PCI的AMI和CKD患者的心脏再住院风险和心源性死亡风险。
