Kida Hirota, Matsuoka Yuki, Sakamoto Daisuke, Hikoso Shungo, Nakatani Daisaku, Okada Katsuki, Sunaga Akihiro, Sato Taiki, Kitamura Tetsuhisa, Sakata Yasuhiko, Sato Hiroshi, Hori Masatsugu, Komuro Issei, Sotomi Yohei, Sakata Yasushi
Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita Japan.
Department of Cardiovascular Medicine Nara Medical University Kashihara Japan.
J Am Heart Assoc. 2025 Jul 15;14(14):e043005. doi: 10.1161/JAHA.125.043005. Epub 2025 Jul 3.
Primary percutaneous coronary intervention is the preferred treatment for acute myocardial infarction. However, in patients with chronic kidney disease (CKD), the use of contrast media can exacerbate renal dysfunction, often necessitating alternative strategies. The impact of CKD on acute myocardial infarction prognosis, particularly in the context of percutaneous coronary intervention, is not fully understood.
This study utilized real-world registry data from the OACIS (Osaka Acute Coronary Insufficiency Study) to evaluate prognosis across different CKD grades, including advanced CKD and hemodialysis. From a database of 12 093 patients with acute myocardial infarction, we identified 8411 patients with renal function data at admission (a median follow-up period of 1765 days). These patients were classified into 8 CKD categories based on estimated glomerular filtration rate (eGFR); G1 (eGFR≥90 mL/min per 1.73 m): n=1122, G2 (90>eGFR ≥60 mL/min per 1.73 m): n=3588, G3a (60>eGFR≥45 mL/min per 1.73 m): n=1923, G3b (45>eGFR≥30 mL/min per 1.73 m): n=1030, G4: (30>eGFR≥15 mL/min per 1.73 m): n=473, G5a: (15>eGFR≥8 mL/min per 1.73m): n=80, G5b: (eGFR<8 mL/min per 1.73 m): n=53 and hemodialysis: n=142. Percutaneous coronary intervention rates declined with advancing CKD, reaching the lowest in G5a (80.3%) but increasing again in G5b and hemodialysis groups (≈90%). Thirty-day all-cause mortality rates increased with CKD severity, with a notable reduction in G5b (9.4%) before rising again in patients with hemodialysis (16.9%). Long-term data showed a progressive worsening of prognosis with advanced CKD, culminating in the poorest outcomes among patients with hemodialysis.
This study demonstrated differential impacts of CKD severity on short- and long-term clinical outcomes in the context of patients with acute myocardial infarction.
直接经皮冠状动脉介入治疗是急性心肌梗死的首选治疗方法。然而，对于慢性肾脏病（CKD）患者，使用造影剂会加重肾功能不全，因此常常需要采取替代策略。CKD对急性心肌梗死预后的影响，尤其是在经皮冠状动脉介入治疗的情况下，尚未完全明确。
本研究利用来自大阪急性冠状动脉功能不全研究（OACIS）的真实世界注册数据，评估不同CKD分级（包括晚期CKD和血液透析）患者的预后。在12093例急性心肌梗死患者的数据库中，我们确定了8411例入院时具有肾功能数据的患者（中位随访期为1765天）。根据估计肾小球滤过率（eGFR）将这些患者分为8个CKD类别；G1（eGFR≥90ml/（min·1.73m²））：n = 1122，G2（90＞eGFR≥60ml/（min·1.73m²））：n = 3588，G3a（60＞eGFR≥45ml/（min·1.73m²））：n = 1923，G3b（45＞eGFR≥30ml/（min·1.73m²））：n = 1030，G4（30＞eGFR≥15ml/（min·1.73m²））：n = 473，G5a（15＞eGFR≥8ml/（min·1.73m²））：n = 80，G5b（eGFR＜8ml/（min·1.73m²））：n = 53，血液透析：n = 142。经皮冠状动脉介入治疗率随CKD进展而下降，在G5a组最低（80.3%），但在G5b组和血液透析组再次升高（≈90%）。30天全因死亡率随CKD严重程度增加，G5b组显著降低（9.4%），然后在血液透析患者中再次升高（16.9%）。长期数据显示，随着CKD进展，预后逐渐恶化，血液透析患者的预后最差。
本研究表明，在急性心肌梗死患者中，CKD严重程度对短期和长期临床结局有不同影响。
