Urinary catheterization prior to PCI worsens clinical outcomes in patients with acute myocardial infarction
Urinary catheterization prior to PCI worsens clinical outcomes in patients with acute myocardial infarction
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PCI 前的导尿术使急性心肌梗死患者的临床结果恶化
DOI：
10.1016/j.jjcc.2022.12.007
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Noguchi T
中科院分区：
文献类型：
--
作者：
4.Suzuki T;Fujino M;Murai K;Iwai T;Sawada K;Matama H;Miura H;Honda S;Yoneda S;Takagi K;Otsuka F;Asaumi Y;Kataoka Y;Tahara Y;Ogata S;Nishimura K;Tsujita K;Noguchi T
背景留置导尿管（IUC）用于测量尿量、让患者卧床休息或保持急性心肌梗死（AMI）患者腹股沟区域的清洁。然而，IUC的使用与院内泌尿相关并发症之间的关系尚不清楚。方法这是对2018-2020年我院收治的303例AMI且无心源性休克的患者进行单中心回顾性分析。在开始侵入性导管治疗后，将 IUC 插入急诊室并尽快取出。主要结局为院内泌尿不良事件（IHAUE），包括院内尿路感染和院内肉眼血尿。结果 303 例患者中，243 例（80.2%）接受了 IUC 置入。接受 IUC 的患者中男性比例较低（72% vs. 85%，p=0.044）。 Killip 分类 2 或 3 级（13% vs. 0%，p=0.003）或 ST 段抬高型心肌梗死（65% vs. 32%，p<0.001）的比例较高。使用 IUC 的患者中 IHAUE 的发生率明显高于未使用 IUC 的患者（11% vs. 2%，p=0.023）。 Kaplan-Meier 分析显示，IHAUE 在有 IUC 的患者中比没有 IUC 的患者更常见（对数秩检验 p=0.033）。此外，与未使用 IUC 的患者相比，IUC 使用时间长于中位数 2 天的 IHAUE 比值比 (OR) 较高（OR，3.65；95% 置信区间，1.28–10.4；p=0.015）。 IUC 状态的院内死亡率没有显着差异。结论 IUC 的使用与无并发症 AMI 患者发生 IHAUE 的较高风险相关。可能不建议常规使用 IUC。
BackgroundIndwelling urethral catheters (IUCs) are used to measure urine volume, keep patients on bed rest, or keep the groin area clean in patients with acute myocardial infarction (AMI). However, the association between IUC use and in-hospital urinary-related complications is unknown.MethodsThis was a single-center retrospective analysis of 303 patients admitted to our hospital in 2018–2020 who had AMI without cardiogenic shock. An IUC was inserted in the emergency room upon initiation of invasive catheter treatment and removed as soon as possible. The primary outcome was in-hospital adverse urinary event (IHAUE), which consisted of in-hospital urinary tract infection and in-hospital gross hematuria.ResultsOf 303 patients, 243 patients (80.2 %) underwent IUC insertion. A lower proportion of patients with IUCs were male (72 % vs. 85 %,p= 0.044). A higher proportion had Killip classification 2 or 3 (13 % vs. 0 %,p= 0.003) or ST-elevation myocardial infarction (65 % vs. 32 %,p< 0.001). IHAUEs occurred significantly more commonly in patients with IUCs than without IUCs (11 % vs. 2 %,p= 0.023). Kaplan-Meier analysis showed that IHAUEs occurred more frequently in patients with IUCs than patients without IUCs (log-rank testp= 0.033). Furthermore, IUC use longer than the median of 2 days was associated with a higher odds ratio (OR) for IHAUE when compared with those without IUC use (OR, 3.65; 95 % confidence interval, 1.28–10.4;p= 0.015). There were no significant differences in in-hospital mortality by IUC status.ConclusionsIUC use is associated with a higher risk of IHAUEs in patients with uncomplicated AMI. Routine IUC use might not be recommended.