经皮冠状动脉介入治疗后需要透析的急性肾损伤：来自PROGRESS-并发症注册研究的见解
Acute Kidney Injury Requiring Dialysis Following Percutaneous Coronary Intervention: Insights From the PROGRESS-COMPLICATIONS Registry.
作者信息
Mutlu Deniz, Ser Ozgur Selim, Strepkos Dimitrios, Carvalho Pedro E, Alexandrou Michaella, Kladou Eleni, Mastrodemos Olga, Rangan Bavana V, Sara Jaskanwal Deep Singh, Jalli Sandeep, Voudris Konstantinos, Sandoval Yader, Nicholas Burke M, Brilakis Emmanouil S
机构信息
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
出版信息
Catheter Cardiovasc Interv. 2025 Sep;106(3):1883-1891. doi: 10.1002/ccd.70012. Epub 2025 Jul 17.
BACKGROUND
Acute kidney injury (AKI) requiring dialysis is a potentially life-threatening complication of percutaneous coronary intervention (PCI).
AIMS
To assess the clinical and procedural characteristics and the outcomes of patients with AKI requiring dialysis after PCI.
METHODS
We examined the clinical, procedural characteristics and outcomes of AKI requiring dialysis after PCI from a contemporary PCI complication registry (NCT05100940).
RESULTS
Between 2016 and 2023, dialysis was required in 119 of 18,691 PCI patients (0.6%). Mean patient age was 71 ± 11 years, and 58.8% were men, with a high prevalence of diabetes mellitus (38.7%), chronic kidney disease (73.9%), hypertension (84.0%), heart failure (67.8%), and prior myocardial infarction (54.0%). The median baseline creatinine was 1.6 (interquartile range 1.3-2.5) mg/dL. The indication for PCI was an acute coronary syndrome in most patients (94.9%); 28 (23.5%) had preprocedural cardiac arrest (CA) and 14 (11.7%) had cardiogenic shock (CS). The most common target vessel was the left anterior descending artery (44.2%). Bifurcation lesions (37.0%), and moderate/severe calcification (53.5%) were common. Total median contrast volume was 130 (88-200) mL. Median length of hospital stay was 11 days (7-17 days). Technical success was 73.9%. In hospital mortality occurred in 48.7%, hypotension in 43.7%, and major bleeding in 30.3%. During a median follow-up of 35 (9-900) days, patients with AKI requiring dialysis had high incidence of major adverse cardiovascular events (MACE) (63.6%), driven by high mortality (62.1%).
CONCLUSIONS
AKI requiring dialysis after PCI occurred in 0.6% of patients and was associated with high in-hospital and follow-up mortality and MACE.
背景
需要透析的急性肾损伤（AKI）是经皮冠状动脉介入治疗（PCI）的一种潜在危及生命的并发症。
目的
评估PCI术后需要透析的AKI患者的临床和手术特征及预后。
方法
我们从一个当代PCI并发症登记处（NCT05100940）检查了PCI术后需要透析的AKI患者的临床、手术特征及预后。
结果
2016年至2023年期间，18691例PCI患者中有119例（0.6%）需要透析。患者平均年龄为71±11岁，男性占58.8%，糖尿病（38.7%）、慢性肾脏病（73.9%）、高血压（84.0%）、心力衰竭（67.8%）和既往心肌梗死（54.0%）的患病率较高。基线肌酐中位数为1.6（四分位间距1.3 - 2.5）mg/dL。大多数患者（94.9%）PCI的指征是急性冠状动脉综合征；28例（23.5%）术前发生心脏骤停（CA），14例（11.7%）发生心源性休克（CS）。最常见的靶血管是左前降支动脉（44.2%）。分叉病变（37.0%）和中度/重度钙化（53.5%）很常见。造影剂总量中位数为130（88 - 200）mL。住院时间中位数为11天（7 - 17天）。技术成功率为73.9%。住院死亡率为48.7%，低血压发生率为43.7%，大出血发生率为30.3%。在中位随访35（9 - 900）天期间，需要透析的AKI患者主要不良心血管事件（MACE）发生率较高（63.6%），主要由高死亡率（62.1%）导致。
结论
PCI术后需要透析的AKI发生在0.6%的患者中，与高住院率、随访死亡率和MACE相关。
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