Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry.
Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry.
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DOI：
10.1016/j.jcin.2013.06.016
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发表时间：
2014-01
影响因子：
11.3
通讯作者：
Spertus, John A.
中科院分区：
文献类型：
--
作者：
Tsai, Thomas T.;Patel, Uptal D.;Chang, Tara I.;Kennedy, Kevin F.;Masoudi, Frederick A.;Matheny, Michael E.;Kosiborod, Mikhail;Amin, Amit P.;Messenger, John C.;Rumsfeld, John S.;Spertus, John A.
这项研究试图调查接受经皮冠状动脉介入治疗的患者急性肾损伤的当代发生率、预测因素和结果。急性肾损伤(AKI)是经皮冠状动脉介入治疗(PCI)的一种严重的、潜在的可预防的并发症，与不良结局相关。当代AKI的发病率、预测因子和结果还没有很好的定义，澄清这些可以帮助识别高危患者进行积极预防。从2009年6月到2011年6月，共有985,737名患者在1,253个参与国家心血管数据注册中心Cath-PCI注册的地点接受了经皮冠状动脉介入治疗。根据急性肾损伤网络(AKIN)标准，根据医院内血清肌酐水平的变化来定义AKI。使用带有广义估计方程的多变量回归分析，我们确定了与AKI相关的患者特征。总体而言，69,658名患者(7.1%)经历了AKI，其中3,005名患者(0.3%)需要新的透析。多因素分析显示，ST段抬高心肌梗死(STEMI)、严重慢性肾脏疾病(OR：3.59；95%CI：3.47~3.71)、心源性休克(OR：2.92；95%CI：2.80~3.04)、ST段抬高心肌梗死(OR：2.60；95%可信区间：2.53~2.67)与急性心肌梗死发病相关。急性心肌梗死患者的住院死亡率为9.7%，需要透析的患者为34%，而非急性心肌梗死患者的住院死亡率为0.5%(p<；0.001)。多变量调整后，急性肾功能衰竭(OR：7.8；95%CI：7.4%~8.1P<；0.001)和透析(OR：21.7%CI：19.6%~24.1；P<；0.001)仍然是住院死亡率的独立预测因素。大约7%的接受经皮冠状动脉介入治疗的患者发生了急性心肌梗死，这与住院死亡率密切相关。为了提高介入治疗的安全性和治疗效果，需要制定策略以最大限度地降低接受冠状动脉介入治疗的患者发生急性心肌梗死的风险。
This study sought to examine the contemporary incidence, predictors and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions. Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary interventions (PCIs) that is associated with adverse outcomes. The contemporary incidence, predictors, and outcomes of AKI are not well defined, and clarifying these can help identify high-risk patients for proactive prevention. A total of 985,737 consecutive patients underwent PCIs at 1,253 sites participating in the National Cardiovascular Data Registry Cath-PCI registry from June 2009 through June 2011. AKI was defined on the basis of changes in serum creatinine level in the hospital according to the Acute Kidney Injury Network (AKIN) criteria. Using multivariable regression analyses with generalized estimating equations, we identified patient characteristics associated with AKI. Overall, 69,658 (7.1%) patients experienced AKI, with 3,005 (0.3%) requiring new dialysis. On multivariable analyses, the factors most strongly associated with development of AKI included ST-segment elevation myocardial infarction (STEMI) presentation (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 2.53 to 2.67), severe chronic kidney disease (OR: 3.59; 95% CI: 3.47 to 3.71), and cardiogenic shock (OR: 2.92; 95% CI: 2.80 to 3.04). The in-hospital mortality rate was 9.7% for patients with AKI and 34% for those requiring dialysis compared with 0.5% for patients without AKI (p < 0.001). After multivariable adjustment, AKI (OR: 7.8; 95% CI: 7.4 to 8.1, p <0.001) and dialysis (OR: 21.7; 95% CI: 19.6 to 24.1; p <0.001) remained independent predictors of in-hospital mortality. Approximately 7% of patients undergoing a PCI experience AKI, which is strongly associated with in-hospital mortality. Defining strategies to minimize the risk of AKI in patients undergoing PCI are needed to improve the safety and outcomes of the procedure.
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DOI：
10.1093/ndt/gfl213
发表时间：
2006-06-01
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
作者：
Finn, William F
通讯作者：
Finn, William F
影响因子：
2.3
作者：
Lindsay, J;Apple, S;Waksman, R
通讯作者：
Waksman, R
影响因子：
2.8
作者：
Freeman, RV;O'Donnell, M;Moscucci, M
通讯作者：
Moscucci, M
影响因子：
--
作者：
Amin, Amit P.;Salisbury, Adam C.;Kosiborod, Mikhail
通讯作者：
Kosiborod, Mikhail
影响因子：
5.4
作者：
Brown JR;McCullough PA;Splaine ME;Davies L;Ross CS;Dauerman HL;Robb JF;Boss R;Goldberg DJ;Fedele FA;Kellett MA;Phillips WJ;Ver Lee PN;Nelson EC;MacKenzie TA;O'Connor GT;Sarnak MJ;Malenka DJ;Northern New England Cardiovascular Disease Study Group
通讯作者：
Northern New England Cardiovascular Disease Study Group