Cosentino Nicola, Genovesi Simonetta, Bonomi Alice, Trombara Filippo, Ludergnani Monica, Leoni Olivia, Bortolan Francesco, Agostoni Piergiuseppe, Marenzi Giancarlo
Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.
School of Medicine and Surgery, Nephrology Clinic, Milano-Bicocca University, 20900 Monza, Italy.
Rev Cardiovasc Med. 2023 Apr 28;24(5):135. doi: 10.31083/j.rcm2405135. eCollection 2023 May.
Patients on chronic dialysis are less likely to be treated with percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). This is due to the lack of evidence from randomized trials, concerns about possible PCI-related side effects, and multimorbidity. Therefore, routine use of PCI for treatment of dialysis patients with AMI remains an unresolved issue.
We analyzed data of patients on chronic dialysis hospitalized with AMI from 2003 to 2018, by using the administrative Lombardy Health Database (Italy). Patients were grouped according to whether they underwent or not PCI during index hospitalization. The primary outcome was in-hospital mortality, 1-year mortality was the secondary endpoint.
During the study period, 265,048 patients were hospitalized with AMI. Of them, 3206 (1.2%) were on chronic dialysis (age 71 11; 72% males). Among dialysis patients, 44% underwent PCI, while 54% underwent PCI among non-dialysis patients ( 0.0001). Dialysis was an independent predictor of treatment with medical therapy only (OR 0.75 [95% CI 0.70-0.81]). In-hospital mortality in the dialysis cohort was 15%, significantly lower in patients treated with PCI than in those not treated with PCI (11% vs. 19%; 0.0001). One-year mortality was 47% and it was lower in PCI-treated patients (33% vs. 52%; 0.0001). The adjusted risk of the study endpoints was significantly lower in dialysis patients undergoing PCI: OR 0.62 (95% CI 0.50-0.76) for in-hospital mortality; HR 0.63 (95% CI 0.56-0.71) for 1-year mortality.
This study showed that in AMI patients on chronic dialysis, PCI is associated with a significant in-hospital and 1-year survival benefit. Yet, they underwent PCI less frequently than patients with preserved renal function.
慢性透析患者因急性心肌梗死（AMI）接受经皮冠状动脉介入治疗（PCI）的可能性较小。这是由于缺乏随机试验的证据、对PCI相关副作用的担忧以及多种合并症。因此，对于透析患者AMI的治疗常规使用PCI仍然是一个未解决的问题。
我们使用伦巴第行政区卫生数据库（意大利）分析了2003年至2018年因AMI住院的慢性透析患者的数据。患者根据在索引住院期间是否接受PCI进行分组。主要结局是住院死亡率，1年死亡率是次要终点。
在研究期间，265,048例患者因AMI住院。其中，3206例（1.2%）为慢性透析患者（年龄71±11岁；72%为男性）。在透析患者中，44%接受了PCI，而非透析患者中这一比例为54%（P<0.0001）。透析是仅接受药物治疗的独立预测因素（OR 0.75 [95%CI 0.70-0.81]）。透析队列中的住院死亡率为15%，接受PCI治疗的患者显著低于未接受PCI治疗的患者（11%对19%；P<0.0001）。1年死亡率为47%，PCI治疗患者较低（33%对52%；P<0.0001）。接受PCI的透析患者研究终点的调整风险显著降低：住院死亡率的OR为0.62（95%CI 0.50-0.76）；1年死亡率的HR为0.63（95%CI 0.56-0.71）。
本研究表明，在慢性透析的AMI患者中，PCI与显著的住院和1年生存获益相关。然而，他们接受PCI的频率低于肾功能正常的患者。
