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经皮冠状动脉介入治疗后肾功能受损与10年预后——与年龄、性别、糖尿病状态及临床表现的相互作用

Impaired Kidney Function and 10-Year Outcome After Percutaneous Coronary Intervention-Interaction with Age, Sex, Diabetic Status and Clinical Presentation.

作者信息

Ndrepepa Gjin, Kufner Sebastian, Cassese Salvatore, Joner Michael, Sager Hendrik B, Xhepa Erion, Laugwitz Karl-Ludwig, Schunkert Heribert, Kastrati Adnan

机构信息

Department of Cardiology, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstrasse 36, 80636 München, Germany.

German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.

出版信息

J Clin Med. 2024 Nov 13;13(22):6833. doi: 10.3390/jcm13226833.

Abstract

: Limited evidence exists regarding the association of chronic kidney disease (CKD) with long-term outcomes following percutaneous coronary intervention (PCI). We aimed to assess the association of CKD with 10-year outcome after PCI. This study included 5571 patients with coronary artery disease (CAD) undergoing PCI. Patients were categorized in groups according to the estimated glomerular filtration rate (eGFR) values: eGFR ≥ 90 mL/min/1.73 m, (normal kidney function), 60 to <90 mL/min/1.73 m (mild kidney impairment), 30 to <60 mL/min/1.73 m (mild-to-moderate and moderate-to-severe kidney impairment) and <30 mL/min/1.73 m (severe kidney impairment). The primary endpoint was all-cause mortality at 10 years. All-cause deaths occurred in 155 patients (86.3%) with eGFR < 30 mL/min/1.73 m, 602 patients (59.1%) with eGFR 30 to <60 mL/min/1.73 m, 775 patients (31.3%) with eGFR 60 to <90 mL/min/1.73 m and 220 patients (15.8%) with eGFR ≥ 90 mL/min/1.73 m (adjusted hazard ratio = 2.16, 95% confidence interval 1.84 to 2.54, < 0.001, for 30 mL/min/1.73 m decrement in the eGFR). There were CKD-by-age (Pint < 0.001) and CKD-by-clinical presentation (Pint = 0.017) interactions showing a stronger association of CKD with mortality in younger patients and those presenting with acute coronary syndromes. The C statistic of the multivariable model for mortality increased from 0.748 [0.737-0.759] to 0.766 [0.755-0.777] ( < 0.001) after the inclusion of eGFR in the model. In patients with CAD undergoing PCI, CKD was associated with higher mortality at 10 years compared with patients with preserved renal function. The association between CKD and mortality was stronger in patients of younger age and those presenting with acute coronary syndromes.

摘要

关于慢性肾脏病(CKD)与经皮冠状动脉介入治疗(PCI)后长期预后的关联,现有证据有限。我们旨在评估CKD与PCI后10年预后的关联。本研究纳入了5571例接受PCI的冠状动脉疾病(CAD)患者。根据估计肾小球滤过率(eGFR)值将患者分为几组:eGFR≥90 mL/(min·1.73 m²)(肾功能正常)、60至<90 mL/(min·1.73 m²)(轻度肾功能损害)、30至<60 mL/(min·1.73 m²)(轻度至中度和中度至重度肾功能损害)以及<30 mL/(min·1.73 m²)(重度肾功能损害)。主要终点是10年全因死亡率。eGFR<30 mL/(min·1.73 m²)的患者中有155例(86.3%)发生全因死亡,eGFR 30至<60 mL/(min·1.73 m²)的患者中有602例(59.1%),eGFR 60至<90 mL/(min·1.73 m²)的患者中有775例(31.3%),eGFR≥90 mL/(min·1.73 m²)的患者中有220例(15.8%)(eGFR每降低30 mL/(min·1.73 m²),调整后风险比=2.16,95%置信区间1.84至2.54,P<0.001)。存在CKD与年龄的交互作用(P交互<0.001)以及CKD与临床表现的交互作用(P交互=0.017),表明在年轻患者和表现为急性冠状动脉综合征的患者中,CKD与死亡率的关联更强。将eGFR纳入模型后,死亡率多变量模型的C统计量从0.748[0.737 - 0.759]增至0.766[0.755 - 0.777](P<0.001)。在接受PCI的CAD患者中,与肾功能正常的患者相比,CKD与10年更高的死亡率相关。在年轻患者和表现为急性冠状动脉综合征的患者中,CKD与死亡率的关联更强。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cc6/11594875/9c432e616aee/jcm-13-06833-g001.jpg

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