Acute Kidney Injury Among Older Patients Undergoing Coronary Angiography for Acute Myocardial Infarction: The SILVER-AMI Study
Acute Kidney Injury Among Older Patients Undergoing Coronary Angiography for Acute Myocardial Infarction: The SILVER-AMI Study
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急性心肌梗死患者行冠状动脉造影的老年患者中的急性肾损伤：SILVER - AMI研究
DOI：
10.1016/j.amjmed.2019.05.022
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发表时间：
2019-12-01
影响因子：
5.9
通讯作者：
Chaudhry, Sarwat, I
中科院分区：
文献类型：
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作者：
Dodson, John A.;Hajduk, Alexandra;Chaudhry, Sarwat, I
背景：在因急性心肌梗死住院的老年人（年龄≥75岁）中，冠状动脉造影后急性肾损伤很常见。衰老相关疾病可以独立预测急性肾损伤，但尚未在大型急性心肌梗死队列中进行分析。 方法：我们分析了老年急性心肌梗死患者危险因素综合评估 (SILVER-AMI) 研究中 2212 名年龄 >= 75 岁且接受冠状动脉造影的参与者的数据。急性肾损伤的定义是使用改善肾脏疾病全球结局 (KDIGO) 标准（血清 Cr 较基线增加 >= 0.3 mg/dL 或 >= 1.5 倍基线）。我们分析了传统急性肾损伤危险因素和衰老相关病症（日常生活活动障碍、跌倒史、恶病质、体力活动不足）与急性肾损伤的关联，然后进行逻辑回归以确定独立预测因素。 结果：参与者的平均年龄为 81.3 岁，45.2% 为女性，9.5% 为非白人； 421 人 (19.0%) 经历过急性肾损伤。合并症和衰老相关疾病在经历急性肾损伤的个体中更为常见。然而，经过多变量调整后，没有保留与老化相关的条件。最终模型中有11个风险因素；最强的是就诊时的心力衰竭（比值比 [OR] 1.91；95% 置信区间 [CI]，1.41-2.59）、体重指数 [BMI] >30（相对 BMI 18-25：OR 1.75；95% CI，1.27-2.42）和非白人种族（OR 1.65；95% CI， 1.16-2.33）。最终模型的接收者操作特征曲线下面积为 0.72，并且经过良好校准 (Hosmer-Lemeshow P = .50)。急性肾损伤与 6 个月死亡率独立相关（OR 1.98；95% CI，1.36-2.88），但与再入院无关（OR 1.26；95% CI，0.98-1.61）。结论：急性肾损伤在接受冠状动脉造影的急性心肌梗死老年人中很常见。预测因素在很大程度上反映了之前对年轻人的研究，这表明老年疾病通过其他风险因素调节其影响。 (C) 2019 Elsevier Inc. 保留所有权利。
BACKGROUND: Among older adults (age >= 75 years) hospitalized for acute myocardial infarction, acute kidney injury after coronary angiography is common. Aging-related conditions may independently predict acute kidney injury, but have not yet been analyzed in large acute myocardial infarction cohorts.METHODS: We analyzed data from 2212 participants age >= 75 years in the Comprehensive Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study who underwent coronary angiography. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes (KDIGO) criteria (serum Cr increase >= 0.3 mg/dL from baseline or >= 1.5 times baseline). We analyzed the associations of traditional acute kidney injury risk factors and aging-related conditions (activities of daily living impairment, prior falls, cachexia, low physical activity) with acute kidney injury, and then performed logistic regression to identify independent predictors.RESULTS: Participants' mean age was 81.3 years, 45.2% were female, and 9.5% were nonwhite; 421 (19.0%) experienced acute kidney injury. Comorbid diseases and aging-related conditions were both more common among individuals experiencing acute kidney injury. However, after multivariable adjustment, no aging-related conditions were retained. There were 11 risk factors in the final model; the strongest were heart failure on presentation (odds ratio [OR] 1.91; 95% confidence interval [CI], 1.41-2.59), body mass index [BMI] >30 (vs BMI 18-25: OR 1.75; 95% CI, 1.27-2.42), and nonwhite race (OR 1.65; 95% CI, 1.16-2.33). The final model achieved an area under the receiver operating characteristic curve of 0.72 and was well calibrated (Hosmer-Lemeshow P = .50). Acute kidney injury was independently associated with 6-month mortality (OR 1.98; 95% CI, 1.36-2.88) but not readmission (OR 1.26; 95% CI, 0.98-1.61).CONCLUSIONS: Acute kidney injury is common among older adults with acute myocardial infarction undergoing coronary angiography. Predictors largely mirrored those in previous studies of younger individuals, which suggests that geriatric conditions mediate their influence through other risk factors. (C) 2019 Elsevier Inc. All rights reserved.