Heyuan People's Hospital, Guangdong Provincial People's Hospital, Heyuan Hospital, Heyuan, China.
Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Ren Fail. 2024 Dec;46(2):2398189. doi: 10.1080/0886022X.2024.2398189. Epub 2024 Sep 4.
Advanced chronic kidney disease (CKD) is common among patients with coronary artery disease (CAD), and angiotensin‑converting enzyme inhibitors (ACEI) or angiotensin‑receptor blockers (ARB) can improve cardiac and renal function, but whether ACEI/ARB therapy improves long-term prognosis remains unclear among these high-risk patients. Therefore, this research aimed to investigate the relationship between ACEI/ARB therapy and long-term prognosis among CAD patients with advanced CKD.
CAD patients with advanced CKD were included in five hospitals. Advanced CKD was defined as estimated glomerular filtration rate (eGFR)<30 ml/min per 1.73 m. Cox regression models and competing risk Fine and Gray models were used to examine the relationship between ACEI/ARB therapy and all-cause and cardiovascular death, respectively.
Of 2527 patients, 47.6% population of our cohort was discharged on ACEI/ARB. The overall all-cause and cardiovascular mortality were 38.6% and 24.7%, respectively. Multivariate Cox regression analyses indicated that ACEI/ARB therapy was found to be associated with lower rates of both all-cause mortality (hazard ratio (HR)=0.836, 95% confidence interval (CI): 0.738-0.948, = 0.005) and cardiovascular mortality (HR = 0.817, 95%CI: 0.699-0.956, = 0.011). In the propensity-matched cohort, the survival benefit was consistent, and significantly better survival was observed for all-cause mortality (HR = 0.856, 95%CI: 0.752-0.974, = 0.019) and cardiovascular mortality (HR = 0.830, 95%CI: 0.707-0.974, = 0.023) among patients treated with ACEI/ARB.
ACEI/ARB therapy showed a better survival benefit among high-risk CAD patients with advanced CKD at long-term follow-up, which manifested that strategies to maintain ACEI/ARB treatment may improve clinical outcomes among these high-risk populations.
慢性肾脏病（CKD）晚期在冠心病（CAD）患者中较为常见，血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）可改善心脏和肾脏功能，但 ACEI/ARB 治疗是否能改善这些高危患者的长期预后尚不清楚。因此，本研究旨在探讨 ACEI/ARB 治疗与 CKD 晚期 CAD 患者的长期预后之间的关系。
纳入五家医院的 CKD 晚期 CAD 患者。晚期 CKD 定义为估算肾小球滤过率（eGFR）<30 ml/min/1.73 m。采用 Cox 回归模型和竞争风险 Fine 和 Gray 模型分别检验 ACEI/ARB 治疗与全因和心血管死亡之间的关系。
在 2527 例患者中，我们队列的 47.6%人群出院时接受 ACEI/ARB 治疗。全因和心血管死亡率分别为 38.6%和 24.7%。多变量 Cox 回归分析表明，ACEI/ARB 治疗与全因死亡率（风险比（HR）=0.836，95%置信区间（CI）：0.738-0.948， = 0.005）和心血管死亡率（HR = 0.817，95%CI：0.699-0.956， = 0.011）均呈负相关。在倾向匹配队列中，生存获益一致，ACEI/ARB 治疗组全因死亡率（HR = 0.856，95%CI：0.752-0.974， = 0.019）和心血管死亡率（HR = 0.830，95%CI：0.707-0.974， = 0.023）显著改善。
在长期随访中，ACEI/ARB 治疗对 CKD 晚期高危 CAD 患者的生存获益更好，这表明维持 ACEI/ARB 治疗的策略可能改善这些高危人群的临床结局。
