Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine
Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine
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DOI：
10.1002/ccd.10534
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发表时间：
2003-07-01
影响因子：
2.3
通讯作者：
Waksman, R
中科院分区：
文献类型：
--
作者：
Lindsay, J;Apple, S;Waksman, R
在慢性肾功能不全患者中，经皮冠状动脉介入治疗（PCI）后肾功能（DRF）进一步下降不仅伴随着不良院内事件，而且还增加了1年时死亡率和心肌梗死的风险。本分析旨在确定肾功能正常的患者在PCI后发生DRF时，1年时死亡和心肌梗死的风险是否有可比性增加，以及该风险是否与院内并发症（死亡、心肌梗死、紧急冠状动脉旁路移植术）无关。我们对来自一家中心的所有患者进行了回顾性分析，这些患者成功接受了PCI，无重大院内并发症，PCI前血清肌酐（SCr）≤ 1.2 mg/dl，无肾功能不全病史。通过邮件或电话获得1年随访。共有5，967名连续患者符合入选标准。其中，208例（3.5%）发生DRF（SCr增加大于或等于基线的50%）。他们更可能是老年人、女性、非高加索人、糖尿病患者和/或高血压患者。他们报告了更多的既往脑或外周血管事件。与96.5%未发生DRF的患者相比，他们接受了更复杂的PCI，暴露于更多的放射造影剂。校正基线变量后，DRF仍然是1年死亡率、心肌梗死和靶血管血运重建的独立预测因子。在既往无肾损害的患者中，PCI后DRF罕见，但与慢性肾功能不全患者中晚期不良心脏事件的风险增加相关。(C)2003 Wiley-Liss，Inc.
In patients with chronic renal insufficiency, further decline in renal function (DRF) after percutaneous Coronary intervention (PCI) is accompanied not only by adverse in-hospital events but also by increased risk of mortality and myocardial infarction at I year. This analysis was undertaken to determine if patients with normal renal function who develop DRF after PCI have a comparable increase in risk of death and myocardial infarction at 1 year, and whether this risk is independent of in-hospital complications (death, myocardial infarction, urgent coronary artery bypass grafting). We performed a retrospective analysis of all patients from a single center who underwent successful PCI with no major in-hospital complications who had pre-PCI serum creatinine (SCr) less than or equal to 1.2 mg/dl and no history of renal insufficiency. One-year follow-up was obtained by mail or telephone. There were 5,967 consecutive patients who met the inclusion criteria. Of these, 208 (3.5%) developed DRF (an increase in SCr greater than or equal to 50% of baseline). They were more likely to be older, female, non-Caucasian, diabetic and/or hypertensive. They reported more prior cerebral or peripheral vascular events. They had undergone more complex PCI and were exposed to more radiographic contrast than the 96.5% who did not develop DRF. After adjustment for baseline variables, DRF remained an independent predictor of 1-year mortality, myocardial infarction, and target vessel revascularization. In patients without prior renal impairment, DRF post-PCI is rare but is associated with an increased risk of late adverse cardiac events similar to that in chronic renal insufficiency patients. (C) 2003 Wiley-Liss, Inc.