Health status and quality of life in patients with stable coronary artery disease and chronic kidney disease treated with optimal medical therapy or percutaneous coronary intervention (post hoc findings from the COURAGE trial).
Health status and quality of life in patients with stable coronary artery disease and chronic kidney disease treated with optimal medical therapy or percutaneous coronary intervention (post hoc findings from the COURAGE trial).
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DOI：
10.1016/j.amjcard.2013.07.034
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发表时间：
2013-12-01
期刊：
影响因子：
--
通讯作者：
COURAGE Study Investigators
中科院分区：
文献类型：
--
作者：
Sedlis SP;Jurkovitz CT;Hartigan PM;Kolm P;Goldfarb DS;Lorin JD;Dada M;Maron DJ;Spertus JA;Mancini GB;Teo KK;Boden WE;Weintraub WS;COURAGE Study Investigators
慢性肾脏病(CKD)是一种重要的临床并存疾病，即使在接受指南指导的治疗时，它也会增加冠心病(CAD)患者死亡和心肌梗死的风险。然而，目前尚不清楚慢性肾脏病是否会影响冠心病治疗对患者健康状况、症状、功能和生活质量的影响。我们利用血管重建和积极药物评估(CORAGE)研究对临床结果进行了特殊分析，以比较患有和不患有CKD的稳定型CAD患者的健康状况，CKD的定义是肾小球滤过率为60毫升/分钟/1.73平方米，随机分为经皮冠状动脉介入治疗(PCI)和最佳药物治疗(OMT)或仅接受OMT。使用西雅图心绞痛问卷对310名CKD患者和1719名非CKD患者在基线、1、3、6、12、24和36个月的随访时进行健康状况评估。采用线性混合效应模型对西雅图心绞痛问卷得分进行纵向分析。心绞痛相关生活质量、心绞痛频率和身体限制领域的平均得分在患有和不患有慢性肾脏病和高原的患者中都比基线值有所改善。早期改善(1-6个月)在接受PCI加OMT治疗的患者中比单纯接受OMT治疗的患者更常见，在有和没有CKD的患者中都是如此。所有组的治疗满意度得分在基线时都很高，并且随着时间的推移没有显著变化。总之，虽然慢性肾脏病是稳定性冠心病患者无事件生存的重要决定因素，但它既不排除心绞痛的满意治疗，也不排除单用经皮冠状动脉介入治疗加OMT或单纯OMT治疗，也不排除与不满意的生活质量有关。
Chronic kidney disease (CKD) is an important clinical co-morbidity that increases the risk of death and myocardial infarction in patients with coronary artery disease (CAD) even when treated with guideline-directed therapies. It is unknown, however, whether CKD influences the effects of CAD treatments on patients’ health status, their symptoms, function, and quality of life. We performed a post hoc analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study to compare health status in patients with stable CAD with and without CKD defined as a glomerular filtration rate of <60 ml/min/1.73 m2 randomized to either percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone. Health status was measured at baseline, 1, 3, 6, 12, 24, and 36 months of follow-up with the Seattle Angina Questionnaire in 310 patients with CKD and 1,719 patients without CKD. Linear mixed-effects models were used to analyze Seattle Angina Questionnaire scores longitudinally. Mean scores for angina-related quality of life, angina frequency, and physical limitation domains improved from baseline values in both patients with and without CKD and plateaued. Early improvement (1 to 6 months) was more common in patients treated with PCI plus OMT than with OMT alone in both patients with and without CKD. Treatment satisfaction scores were high at baseline in all groups and did not change significantly over time. In conclusion, although CKD is an important determinant of event-free survival in patients with stable CAD, it neither precludes satisfactory treatment of angina with PCI plus OMT or OMT alone nor is it associated with an unsatisfactory quality of life.
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影响因子：
37.8
作者：
Spertus, JA;Jones, P;Fihn, SD
通讯作者：
Fihn, SD
影响因子：
4.8
作者：
Wyrwich, KW;Spertus, JA;Wolinsky, FD
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Wolinsky, FD
影响因子：
2.8
作者：
SPERTUS, JA;WINDER, JA;FIHN, SD
通讯作者：
FIHN, SD
影响因子：
158.5
作者：
Boden, William E.;O'Rourke, Robert A.;Mathien, J.
通讯作者：
Mathien, J.
影响因子：
--
作者：
Parikh, Chirag R.;Coca, Steven G.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.