Impact of chronic kidney disease on the severity of initially diagnosed coronary artery disease and the patient prognosis in the Japanese population
Impact of chronic kidney disease on the severity of initially diagnosed coronary artery disease and the patient prognosis in the Japanese population
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DOI：
10.1007/s00380-010-0061-9
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发表时间：
2011-07-01
影响因子：
1.5
通讯作者：
Yoshimura, Michihiro
中科院分区：
文献类型：
--
作者：
Yagi, Hidenori;Kawai, Makoto;Yoshimura, Michihiro
本研究评估了冠状动脉疾病（CAD）严重程度与传统冠状动脉危险因素、代谢综合征和慢性肾脏疾病（CKD）之间的关系。343例35-90岁冠心病患者分为两组：单支病变组（SVD组）165例，多支病变组（MVD组）178例。比较两组冠心病的危险因素。校正后的多变量分析显示，只有CKD与MVD相关（比值比，2.85; 95%置信区间[CI]，1.76-4.63; P = 0.00002）。接下来，在患者随访期间，对338例患者的CAD、CKD严重程度和随后的主要不良心脏事件（MACE）发生率之间的关系进行了研究。MVD和CKD分期≥ 3期组的MACE风险约为SVD但无CKD分期≥ 3期组的3倍（校正风险比，3.40; 95% CI，1.26-9.17; P = 0.016）。一项统计学分析还表明，MVD和晚期CKD是MACE的更强有力的风险因素。SVD患者与MVD患者的危险因素比较显示，CKD是MVD的最重要危险因素。此外，MVD和晚期CKD同时存在是后续MACE的关键风险因素。因此，为了减少CAD的进展并改善MVD患者的预后，在CAD治疗期间应仔细评估肾脏状态。
This study evaluated the relationship between the severity of coronary artery disease (CAD) and traditional coronary risk factors, metabolic syndrome, and chronic kidney disease (CKD). Three hundred and forty-three patients (35-90 years of age) with initial diagnosis of CAD were separated into two groups: 165 patients with single-vessel coronary artery disease (SVD group) and 178 patients with multivessel coronary artery disease (MVD group). We compared the risk factors for CAD between the two groups. An adjusted multivariate analysis showed that only CKD was associated with MVD (odds ratio, 2.85; 95% confidence interval [CI], 1.76-4.63; P = 0.00002). Next, the relationship between the severity of CAD, CKD, and the incidence of subsequent major adverse cardiac event (MACE) was investigated in 338 patients during the patient follow-up. The risk of MACE was approximately threefold higher in the group with MVD and CKD stage of 3 or greater than in the group with SVD but without CKD stage of 3 or greater (adjusted hazard ratio, 3.40; 95% CI, 1.26-9.17; P = 0.016). A statistical analysis also suggested that having MVD and advanced CKD was a more powerful risk factor for MACE. The comparison of risk factors between patients with SVD and patients with MVD revealed that CKD was the most important risk factor for MVD. In addition, having MVD and advanced CKD together was a crucial risk factor for subsequent MACE. To reduce the progression of CAD and to improve the prognosis of patients with MVD, the renal status should therefore be carefully assessed during treatment for CAD.