Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention
Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention
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DOI：
10.1007/s00380-016-0836-8
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发表时间：
2017-01-01
影响因子：
1.5
通讯作者：
Kimura, Kazuo
中科院分区：
文献类型：
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作者：
Nakahashi, Hidefumi;Kosuge, Masami;Kimura, Kazuo
造影剂肾病（CIN）和慢性肾脏疾病（CKD）与急性心肌梗死（AMI）原发性经皮冠状动脉介入治疗（PCI）后不良预后相关；然而，其综合预后意义尚不清楚。我们招募了577例AMI患者，在症状出现后12小时内接受首次PCI治疗，并在入院时和入院后3天测量血清肌酐。CKD定义为入院时估计肾小球滤过率< 60 ml/min/1.73 m(2)， CIN定义为在最初72小时内肌酐升高< 0.5 mg/dl或< 25%。根据是否存在CKD和CIN对患者进行分层。在无CKD和无CIN的患者中（n = 244），无CKD但有CIN的患者（n = 152）， CKD但没有CIN的患者（n = 127）， CKD和有CIN的患者（n = 54）， 3年主要不良心血管事件（MACE：全因死亡率、非致死性再梗死或需要再住院的心力衰竭的组合）分别为8%、9%、13%和35% （p < 0.001）。多因素分析显示，与无CKD和无CIN相比，MACE与无CKD合并CIN、CKD合并无CIN、CKD合并CIN的风险比（95% CI）分别为0.91 （0.44-1.84,p = 0.79）、1.11 （0.5-2.23,p = 0.77）和2.98 （1.48-6.04,p = 0.002）。在接受初次PCI的AMI患者中，CKD和CIN合并与不良的长期预后显著相关。
Contrast-induced nephropathy (CIN) and chronic kidney disease (CKD) are associated with poor outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI); however, its combined prognostic significance remains unclear. We enrolled 577 patients with AMI undergoing primary PCI within 12 h after symptom onset and measured serum creatinine on admission and the next 3 days. CKD was defined as admission estimated glomerular filtration rate < 60 ml/min/1.73 m(2), and CIN was defined as creatinine increase ae < yen > 0.5 mg/dl or ae < yen > 25 % from baseline within the first 72 h. Patients were stratified according to the presence or absence of CKD and CIN. In patients with no CKD and no CIN (n = 244), no CKD but CIN (n = 152), CKD but no CIN (n = 127), and both CKD and CIN (n = 54), the 3-year major adverse cardiovascular events (MACE: a combination of all-cause mortality, nonfatal reinfarction, or heart failure requiring rehospitalization) were 8, 9, 13, and 35 %, respectively (p < 0.001). Multivariate analysis showed that as compared with no CKD and no CIN, hazard ratios (95 % CI) for MACE associated with no CKD but CIN, CKD but no CIN, and both CKD and CIN were 0.91 (0.44-1.84; p = 0.79), 1.11 (0.5-2.23; p = 0.77), and 2.98 (1.48-6.04; p = 0.002), respectively. In patients with AMI undergoing primary PCI, the combination of CKD and CIN is significantly associated with adverse long-term outcomes.