Acute renal failure requiring dialysis after percutaneous coronary interventions
Acute renal failure requiring dialysis after percutaneous coronary interventions
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DOI：
10.1002/ccd.1093
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发表时间：
2001-04-01
影响因子：
2.3
通讯作者：
Leon, MB
中科院分区：
文献类型：
--
作者：
Gruberg, L;Mehran, R;Leon, MB
需要透析的急性肾衰竭是经皮冠状动脉介入治疗（PCI）后的一种罕见但严重的并发症，与高住院死亡率和低长期生存率相关。我们分析了经皮冠状动脉介入治疗后透析的发生率、资源利用、短期和长期结局以及预测因素。我们研究了51名入院时未接受透析的连续患者，并与7，690名PCI后不需要透析的患者进行了比较，这些患者在PCI后发生了需要住院透析的急性肾衰竭。需要透析的患者年龄较大，高血压、糖尿病、既往搭桥手术、慢性肾衰竭的发病率较高。左心室射血分数明显降低尽管血管造影成功率相似，但这些患者的院内死亡率（27.5% vs. 1.0%，P < 0.0001）、非Q波心肌梗死（45.7% vs. 14.6%，P < 0.0001）、血管和出血并发症以及住院时间更长。1年随访时，需要透析的患者的死亡率（54.5% vs. 6.4%，P < 0.0001）、心肌梗死（4.5% vs. 1.6%，P = 0.006）和无事件生存率（38.6% vs. 72.0%，P < 0.0001）显著低于不需要透析的患者。多变量分析显示，院内透析和基线血清肌酐水平升高是院内和长期死亡率的最重要预测因素。因此，经皮冠状动脉介入治疗后需要透析的急性肾衰竭与非常高的住院和1年死亡率以及医院资源利用率的急剧增加相关。(C)2001 Wiley-Liss，Inc.
Acute renal failure requiring dialysis is a rare but serious complication after percutaneous coronary interventions (PCI), associated with high in-hospital mortality and poor longterm survival. We have analyzed the incidence, resource utilization, short- and long-term outcomes, and predictors of dialysis after percutaneous coronary interventions. We studied 51 consecutive patients who were not on dialysis on admission and developed acute renal failure that required in-hospital dialysis after PCI in comparison to the 7,690 patients who did not require dialysis after PCl. Patients who required dialysis were older, with a higher incidence of hypertension, diabetes, prior bypass surgery, chronic renal failure. and a significantly lower left ventricular ejection fraction. Despite similar angiographic success, these patients had a higher incidence of in-hospital mortality (27.5% vs. 1.0%, P < 0.0001), non-Q-wave myocardial infarction (45.7% vs. 14.6%, P < 0.0001), vascular and bleeding complications, and longer hospitalization. At 1-year follow-up, mortality (54.5% vs. 6.4%, P < 0.0001), myocardial infarction (4.5% vs. 1.6%, P = 0.006), and event-free survival (38.6% vs. 72.0%, P < 0.0001) were significantly worse in patients who required dialysis compared to patients who did not. Multivariate analysis revealed in-hospital dialysis and an increase in baseline serum creatinine levels as the most important predictors of in-hospital and long-term mortality. Thus, acute renal failure that requires dialysis after percutaneous coronary interventions is associated with very high in-hospital and 1-year mortality rates and a dramatic increase in hospital resource utilization. (C) 2001 Wiley-Liss, Inc.