Ma Yu, Fan Hui, Mi Wei, Ma Jing, Deng Yong, Song Yijie, Li Ximing
Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China.
Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin, China.
Front Cardiovasc Med. 2024 Jul 11;11:1384523. doi: 10.3389/fcvm.2024.1384523. eCollection 2024.
Contrast-associated acute kidney injury (CA-AKI) may occur in patients undergoing medical procedures involving x-rays and radiocontrast media, potentially resulting in prolonged renal impairment. However, no effective treatments are available. Therefore, this study aimed to investigate the efficacy of evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in reducing CA-AKI incidence among patients with atherosclerotic cardiovascular disease (ASCVD) undergoing percutaneous coronary intervention.
This retrospective cohort study included patients who underwent percutaneous coronary intervention between January 2020 and December 2021 at Tianjin Chest Hospital. The study endpoint was CA-AKI incidence, and the impact of selection bias and other potential confounding factors was mitigated using bias matching. Overall, 1,642 patients were included in this study: 821 patients received evolocumab treatment before contrast agent application, and 821 did not receive such treatment.
CA-AKI incidence was 6.21% and 8.04% in the evolocumab and control groups, respectively. After propensity-score matching, the incidence rate was 5.09% and 14.16% in the evolocumab and control groups, respectively. Evolocumab treatment significantly reduced CA-AKI incidence (< 0.001). Consistent findings were obtained in the subgroups of individuals with type II diabetes mellitus, chronic heart failure, and hypertension. Evolocumab exhibited a significantly greater protective effect in the high- and extremely high-risk populations than in the low- and middle-risk populations (< 0.001).
Evolocumab administration significantly reduced CA-AKI incidence among patients with ASCVD. Notably, this effect was more prominent within the subset of high- and extremely high-risk individuals who were already experiencing CA-AKI.
接受涉及X射线和放射性造影剂的医疗程序的患者可能会发生造影剂相关急性肾损伤（CA-AKI），这可能导致肾功能损害延长。然而，目前尚无有效的治疗方法。因此，本研究旨在探讨前蛋白转化酶枯草溶菌素/克新9型抑制剂依洛尤单抗在降低接受经皮冠状动脉介入治疗的动脉粥样硬化性心血管疾病（ASCVD）患者中CA-AKI发生率方面的疗效。
这项回顾性队列研究纳入了2020年1月至2021年12月在天津市胸科医院接受经皮冠状动脉介入治疗的患者。研究终点为CA-AKI发生率，并通过偏倚匹配减轻选择偏倚和其他潜在混杂因素的影响。本研究共纳入1642例患者：821例患者在应用造影剂前接受依洛尤单抗治疗，821例未接受此类治疗。
依洛尤单抗组和对照组的CA-AKI发生率分别为6.21%和8.04%。倾向得分匹配后，依洛尤单抗组和对照组的发生率分别为5.09%和14.16%。依洛尤单抗治疗显著降低了CA-AKI发生率（<0.001）。在2型糖尿病、慢性心力衰竭和高血压患者亚组中也得到了一致的结果。依洛尤单抗在高危和极高危人群中显示出比低危和中危人群更大的保护作用（<0.001）。
依洛尤单抗给药显著降低了ASCVD患者的CA-AKI发生率。值得注意的是，这种效果在已经发生CA-AKI的高危和极高危个体亚组中更为突出。
