Ischemic and Bleeding Outcomes in Patients Who Underwent Percutaneous Coronary Intervention With Chronic Kidney Disease or Dialysis (from a Japanese Nationwide Registry)
Ischemic and Bleeding Outcomes in Patients Who Underwent Percutaneous Coronary Intervention With Chronic Kidney Disease or Dialysis (from a Japanese Nationwide Registry)
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慢性肾病或透析患者接受经皮冠状动脉介入治疗后的缺血和出血结果（来自日本全国登记处）
DOI：
10.1016/j.amjcard.2023.02.027
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Murohara Toyoaki
中科院分区：
文献类型：
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作者：
Tobe Akihiro;Sawano Mitsuaki;Kohsaka Shun;Ishii Hideki;Tanaka Akihito;Numasawa Yohei;Amano Tetsuya;Nakamura Masato;Ikari Yuji;Murohara Toyoaki
慢性肾脏疾病（CKD）与接受经皮冠状动脉介入治疗（PCI）患者结局之间的关系被认为是双向的;这些患者发生缺血和出血事件的风险较高。根据日本全国PCI登记研究，分析了第二代或新一代药物洗脱支架植入患者出院后1年的缺血性（心血管死亡、非致死性心肌梗死或非致死性缺血性卒中）和出血事件（致死性或非致死性大出血）。排除口服抗凝剂的患者。根据患者的术前肾功能进行分层：CKD 1至2期（估计的肾小球滤过率[eGFR] ≥60 ml/min/1.73 m2）、3期（eGFR 30至59）或4至5期（eGFR <30）或接受透析的患者。总体而言，研究了23，349例患者，包括2，798例CKD 3 - 5（12.0%）患者和1，464例透析患者（6.3%）。在CKD 1-2期、3期、4-5期和透析组中，观察到1年缺血事件的发生率分别为1.5%、5.2%、9.7%和5.3%;在校正协变量后，CKD 3期或4 - 5期患者和接受透析的患者的缺血事件风险高于无CKD患者。与缺血性事件相比，1年出血事件较低，发生率分别为1.5%、2.0%、3.4%和2.3%。此外，在调整协变量后，CKD或透析的存在与出血事件的高风险无关。总之，在当代全国PCI登记研究中，CKD和透析的存在与缺血事件的高风险独立相关，但与出血事件无关，这表明需要改变这些患者的护理模式。
The relation between chronic kidney disease (CKD) and outcomes in patients receiving percutaneous coronary intervention (PCI) is thought to be bidirectional; these patients are at a higher risk of ischemic and bleeding events. From a Japanese nationwide PCI registry, ischemic (cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke) and bleeding events (fatal or nonfatal major bleeding) 1 year after discharge among patients who had second- or newer-generation drug-eluting stent implantation were analyzed. Patients on oral anticoagulants were excluded. Patients were stratified according to their preprocedural renal function: CKD stages 1 to 2 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2), 3 (eGFR 30 to 59), or 4 to 5 (eGFR <30), or those receiving dialysis. Overall, 23,349 patients, including 2,798 patients with CKD 3 to 5 (12.0%) and 1,464 patients on dialysis (6.3%), were investigated. One-year ischemic events were observed in 1.5%, 5.2%, 9.7%, and 5.3% in the CKD stages 1-to-2, 3, 4-to-5, and dialysis groups, respectively; patients with CKD stages 3 or 4 to 5 and those receiving dialysis were associated with higher risks of ischemic events after adjustment of covariates than were patients without CKD. Compared with ischemic events, 1-year bleeding events were low, with incidence rates of 1.5%, 2.0%, 3.4%, and 2.3%, respectively. Furthermore, the presence of CKD or dialysis was not associated with a higher risk of bleeding events after adjustment of covariates. In conclusion, in the contemporary nationwide PCI registry, the presence of CKD and dialysis was independently associated with a higher risk of ischemic events but not with bleeding events, and this suggests a need to alter the models of care delivery in these patients.