Outcomes of Non-ST-Segment Myocardial Infarction During Chronic Heart Failure and End-Stage Renal Disease.
Outcomes of Non-ST-Segment Myocardial Infarction During Chronic Heart Failure and End-Stage Renal Disease.
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慢性心力衰竭和终末期肾病期间非 ST 段心肌梗死的结果。
DOI：
10.1016/j.amjcard.2023.05.007
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Saeed,Omar
中科院分区：
文献类型：
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作者：
Alhuarrat,MajdAlDeen;Alhuarrat,MohammedRasoul;Varrias,Dimitrios;Patel,SnehalR;Sims,DanielB;Latib,Azeem;Jorde,UlrichP;Saeed,Omar
非st段心肌梗死（NSTEMI）经常发生在慢性心力衰竭（HF）和终末期肾病（ESRD）患者中，但侵入性治疗方法的结果尚不清楚。我们试图确定经皮冠状动脉介入治疗（PCI）与单纯内科治疗的住院结果。全国住院患者样本用于捕获2006年至2019年美国的住院情况。慢性心衰和终末期肾病患者入院的NSTEMI由国际疾病分类代码确定。该队列分为仅接受PCI或医疗管理的组。采用多变量logistic回归和倾向匹配对住院结果进行比较。在27,433例住院患者中，8,004例（29%）患者接受了PCI治疗，19,429例（71%）患者仅接受药物治疗。PCI与住院期间较低的调整死亡几率相关（调整优势比0.59,95%可信区间0.52 ~ 0.66,p <0.01）。倾向匹配后，这种关联保持一致（校正优势比0.56,95%置信区间0.49 ~ 0.64,p <0.01），并且在所有HF亚型中都很明显。PCI患者的持续时间更长（5,3至9天vs， 5,3至8天，p <0.01），住院费用更长（107,942美元，70,230美元至173,182美元vs， 44,156美元，24,409美元至80,810美元，p <0.01）。总之，与单纯药物治疗相比，因非stemi入院的HF和ESRD患者接受PCI治疗的住院死亡率较低。有创经皮血运重建术对于适当选择的HF和ESRD患者可能是合理的，但需要随机对照试验来确定其在这一高危人群中的安全性和有效性。
Non–ST-segment myocardial infarction (NSTEMI) occurs frequently in a growing population of patients with chronic heart failure (HF) and end-stage renal disease (ESRD) but outcomes with invasive management approaches are unknown. We sought to determine in-hospital outcomes with percutaneous coronary intervention (PCI) in comparison with medical management only. The National Inpatient Sample was used to capture hospitalizations in the United States from 2006 to 2019. Admissions for NSTEMI in patients with chronic HF and ESRD were identified by International Classification of Diseases codes. The cohort was divided into those that received PCI or medical management only. In-hospital outcomes were compared by multivariable logistic regression and propensity matching. In 27,433 hospitalizations, 8,004 patients (29%) underwent PCI, and 19,429 (71%) were managed with medications only. PCI was associated with lower adjusted odds of death during hospitalization (adjusted odds ratio 0.59, 95% confidence interval 0.52 to 0.66, p <0.01). This association remained consistent after propensity matching (adjusted odds ratio 0.56, 95% confidence interval 0.49 to 0.64, p <0.01) and was apparent across all subtypes of HF. Patients with PCI had greater duration (5, 3, to 9 vs, 5, 3 to 8 days, p <0.01) and cost of hospitalization ($107,942, 70,230 to $173,182 vs, $44,156, 24,409 to $80,810, p <0.01). In conclusion, patients with HF and ESRD admitted for NSTEMI experienced lower in-hospital mortality with PCI in comparison with medical therapy only. Invasive percutaneous revascularization may be reasonable for appropriately selected patients with HF and ESRD but randomized controlled trials are needed to determine its safety and efficacy in this high-risk population.