Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention
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- 作者：Hidefumi Nakahashi ; Masami Kosuge ; Kentaro Sakamaki…
- 关键词：Acute myocardial infarction ; Percutaneous coronary intervention ; Chronic kidney disease ; Contrast ; induced nephropathy ; Prognosis
- 刊名：Heart and Vessels
- 出版年：2017
- 出版时间：January 2017
- 年：2017
- 卷：32
- 期：1
- 页码：22-29
- 全文大小：
- 刊物类别：Medicine
- 刊物主题：Cardiology; Cardiac Surgery; Vascular Surgery; Biomedical Engineering;
- 出版者：Springer Japan
- ISSN：1615-2573
- 卷排序：32
文摘
Contrast-induced nephropathy (CIN) and chronic kidney disease (CKD) are associated with poor outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI); however, its combined prognostic significance remains unclear. We enrolled 577 patients with AMI undergoing primary PCI within 12 h after symptom onset and measured serum creatinine on admission and the next 3 days. CKD was defined as admission estimated glomerular filtration rate <60 ml/min/1.73 m2, and CIN was defined as creatinine increase ≥0.5 mg/dl or ≥25 % from baseline within the first 72 h. Patients were stratified according to the presence or absence of CKD and CIN. In patients with no CKD and no CIN (n = 244), no CKD but CIN (n = 152), CKD but no CIN (n = 127), and both CKD and CIN (n = 54), the 3-year major adverse cardiovascular events (MACE: a combination of all-cause mortality, nonfatal reinfarction, or heart failure requiring rehospitalization) were 8, 9, 13, and 35 %, respectively (p < 0.001). Multivariate analysis showed that as compared with no CKD and no CIN, hazard ratios (95 % CI) for MACE associated with no CKD but CIN, CKD but no CIN, and both CKD and CIN were 0.91 (0.44–1.84; p = 0.79), 1.11 (0.5–2.23; p = 0.77), and 2.98 (1.48–6.04; p = 0.002), respectively. In patients with AMI undergoing primary PCI, the combination of CKD and CIN is significantly associated with adverse long-term outcomes.