Incidence and predictors of myocardial infarction after kidney transplantation
Incidence and predictors of myocardial infarction after kidney transplantation
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DOI：
10.1681/asn.2004070580
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发表时间：
2005-02-01
影响因子：
13.6
通讯作者：
Schnitzler, MA
中科院分区：
文献类型：
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作者：
Lentine, KL;Brennan, DC;Schnitzler, MA
肾移植术后心肌梗死（PTMI）的风险和预测因素尚未得到很好的描述。美国肾脏数据系统收集的登记数据用于回顾性调查1995年至2000年接受移植并以医疗保险为主要付款人的成人首次肾移植受者的PTMI。PTMI事件从账单和死亡记录中确定，参与者在移植后随访3年或直到观察结束（2000年12月31日）。扩展的考克斯风险分析用于识别PTMI的独立临床相关性（风险比[HR]），并将PTMI作为结果预测因子进行检查。在35，847名合格参与者中，PTMI的累积发生率在6、12和36个月时分别为4.3%（95%置信区间[CI]，4.1 - 4.5%）、5.6%（95% CI，5.3 - 5.8%）和11.1%（95% CI，10.7 - 11.5%）。PTMI的危险因素包括受体年龄较大、移植前合并症（糖尿病、心绞痛、外周血管疾病和MI）、老年供体和死亡供体的移植以及移植物功能延迟。妇女、黑人、西班牙裔和就业的接受者的风险降低。PTMI的危险性在诊断为移植后糖尿病后升高（HR，1.60; 95%CI，1.35 - 1.88），在移植物衰竭后显著升高（HR，2.78; 95%CI，2.41 - 3.19）。在单独的分析中，PTMI预测了死亡删失的移植物衰竭（HR，1.89; 95%CI，1.63 - 2.20），并以PTMI后随时间推移而下降的方式强烈预测死亡。PTMI的风险因素包括潜在的可改变的移植后并发症。因为PTMI反过来预测移植失败和死亡，降低PTMI的风险可能会改善肾移植后的结果。
The risk and predictors of post-kidney transplantation myocardial infarction (PTMI) are not well described. Registry data collected by the United States Renal Data System were used to investigate retrospectively PTMI among adult first renal allograft recipients who received a transplant in 1995 to 2000 and had Medicare as the primary payer. PTMI events were ascertained from billing and death records, and participants were followed for up to 3 yr after transplant or until the end of observation (December 31, 2000). Extended Cox's hazards analysis was used to identify independent clinical correlates of PTMI (hazard ratio [HR]) and to examine PTMI as an outcomes predictor. Among 35,847 eligible participants, the cumulative incidence of PTMI was 4.3% (95% confidence interval [CI], 4.1 to 4.5%), 5.6% (95% CI, 5.3 to 5.8%), and 11.1% (95% CI, 10.7 to 11.5%) at 6,12, and 36 mo, respectively. Risk factors for PTMI included older recipient age, pretransplantation comorbidities (diabetes, angina, peripheral vascular disease, and MI), transplantation from older donors and deceased donors, and delayed graft function. Women, blacks, Hispanics, and employed recipients experienced reduced risk. The hazard of PTMI rose after a diagnosis of posttransplantation diabetes (HR, 1.60; 95% CI, 1.35 to 1.88) and markedly increased after graft failure (HR, 2.78; 95% CI, 2.41 to 3.19). In separate analyses, PTMI predicted death-censored graft failure (HR, 1.89; 95% CI, 1.63 to 2.20) and strongly predicted death in a manner that declined with time after PTMI. Risk factors for PTMI include potentially modifiable posttransplantation complications. Because PTMI in turn predicts graft failure and death, reducing the risk for PTMI may improve outcomes after kidney transplantation.