eGFR对行直接PCI治疗的急性心肌梗死患者预后的影响
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摘要
目的分析急性心肌梗死(AMI)患者实施直接经皮冠状动脉介入术(PCI)后估算肾小球滤过率(e GFR)变化与不良心血管事件(MACE)发生的关系,帮助改善患者预后。方法连续选取2014年1月～2016年12月于海南西部中心医院心内科收治的86例急性心肌梗死患者,根据e GFR水平的高低将入选患者分为两组,即正常e GFR组(e GFR高于90.0 ml/min·1.73 m2)和异常e GFR组(e GFR低于90.0 ml/min·1.73m2)。记录并比较两组患者的一般资料、冠状动脉(冠脉)造影结果、治疗后MACE发生情况,并对MACE影响因素的Cox比例风险回归模型进行分析。结果比较两组患者冠脉病变支数、梗死相关动脉及合并左冠脉主干病变等,差异均无统计学意义(P>0.05);异常e GFR组患者的总MACE发生率显著高于正常e GFR组患者(P<0.05);Cox比例风险回归模型分析的结果指出,年龄、糖尿病、e GFR为MACE事件发生的危险因素(P<0.05)。结论当患者血肌酐处于参考范围内,eGFR下降对于急性心肌梗死患者行直接PCI后发生MACE有较好的预测价值,从而对存在MACE发生风险的患者进行积极干预来改善预后。
Objective To analysis between the changes of estimated glomerular filtration rate(eGFR) and major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after primary percutaneous coronary intervention(PCI), and to help to improve patients' outcomes. Methods AMI patients(n=86) were chosen continuously from Department of Cardiology of Hainan Western Central Hospital from Jan. 2014 to Dec. 2016. All patients were divided, according to changes of eGFR, into normal eGFR group(eGFR>90.0 ml/min·1.73 m2) and abnormal eGFR group(eGFR<90.0 ml/min·1.73 m2). The general data, results of coronary angiography(CAG) and incidence of MACE were recorded and compared between 2 groups, and the influencing factors of MACE were analyzed by using Cox proportional hazards regression model. Results The comparisons in numbers of diseased coronary vessels, infarction-related arteries and complicating lesions of left main coronary artery(LMCA) showed that the difference had no statistical significance between 2 groups(P>0.05). The total incidence of MACE was significantly higher in abnormal eGFR group than that in normal eGFR group(P<0.05). The analysis results of Cox proportional hazards regression model showed that age, diabetes and eGFR were risk factors of MACE occurrence(P<0.05). Conclusion When the level of serum creatinine is in reference range, the decreased eGFR has a higher predictive value to MACE occurrence in AMI patients after primary PCI. The patients with MACE risks will be intervened for improving their prognosis.
Objective To analysis between the changes of estimated glomerular filtration rate(eGFR) and major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after primary percutaneous coronary intervention(PCI), and to help to improve patients' outcomes. Methods AMI patients(n=86) were chosen continuously from Department of Cardiology of Hainan Western Central Hospital from Jan. 2014 to Dec. 2016. All patients were divided, according to changes of eGFR, into normal eGFR group(eGFR>90.0 ml/min·1.73 m2) and abnormal eGFR group(eGFR<90.0 ml/min·1.73 m2). The general data, results of coronary angiography(CAG) and incidence of MACE were recorded and compared between 2 groups, and the influencing factors of MACE were analyzed by using Cox proportional hazards regression model. Results The comparisons in numbers of diseased coronary vessels, infarction-related arteries and complicating lesions of left main coronary artery(LMCA) showed that the difference had no statistical significance between 2 groups(P>0.05). The total incidence of MACE was significantly higher in abnormal eGFR group than that in normal eGFR group(P<0.05). The analysis results of Cox proportional hazards regression model showed that age, diabetes and eGFR were risk factors of MACE occurrence(P<0.05). Conclusion When the level of serum creatinine is in reference range, the decreased eGFR has a higher predictive value to MACE occurrence in AMI patients after primary PCI. The patients with MACE risks will be intervened for improving their prognosis.
引文
[1]赵亚男,王晨,蔚有权,等.氯吡格雷联合阿司匹林治疗急性心肌梗死的临床研究[J].中国临床药理学杂志,2015,47(8):595-8.
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[4]吴萃荣,王湛.瑞舒伐他汀与阿托伐他汀对急性心肌梗死患者PCI术后左室重构及近期预后影响的比较[J].实用医学杂志,2015,31(3):470-2.
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[8]李其华,韦金儒,唐泉,等.肾小球滤过率对急性心肌梗死患者直接经皮冠状动脉介入术后预后的影响[J].中国全科医学,2016,19(36):4456-60.
[9]Aissaoui N,Puymirat E,Juilliere Y,et al.Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction:the FAST-MIprogramme[J].EUR J HEART FAIL,2016,18(9):1144-52.
[10]刘莉,叶鹏,Winter MP,等.早发急性心肌梗死的长期结局和风险评估:10年随访研究[J].中华高血压杂志,2017,25(04):311.
[11]Velásquez-Rodríguez J1,Diez-Delhoyo F1,Valero-Masa MJ,et al.Prognostic Impact of Age and Hemoglobin in Acute ST-Segment Elevation Myocardial Infarction Treated With Reperfusion Therapy[J].Am J Cardiol,2017,119(12):1909.
[12]Rifkin DE,Shlipak MG,Katz R,et al.Rapid Kidney Function Decline and Mortality Risk in Older Adults[J].Arch Intern Med,2011,168(20):2212-8.
[13]Arbel Y,Halkin A,Finkelstein A,et al.Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease[J].Can J Cardiol,2013,29(11):1374-81.
[14]廖晨军,王秋实,缪绯,等.脑卒中评分在预测冠心病三支血管病变主要不良临床心血管事件中的应用[J].中国急救医学,2016,36(5):424-9.
[15]Chen CL,Yen DHT,Lin CS,et al.Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients:A retrospective observational study[J].Medicine,2017,96(18):e6743.
[2]李晓峰,徐峰,李林,等.急诊经皮冠脉介入治疗后急性心肌梗死患者氯吡格雷抵抗的发生率及影响因素[J].中国医科大学学报,2015,44(7):632-5.
[3]王勇,王琦,柳兢,等.直接支架植入在急性心肌梗死急诊PCI中的临床应用[J].中国医科大学学报,2015,44(5):468-71.
[4]吴萃荣,王湛.瑞舒伐他汀与阿托伐他汀对急性心肌梗死患者PCI术后左室重构及近期预后影响的比较[J].实用医学杂志,2015,31(3):470-2.
[5]Waheed S,Matsushita K,Sang Y,et al.Combined association of albuminuria and cystatin C-based estimated GFR with mortality,coronary heart disease,and heart failure outcomes:the Atherosclerosis Risk in Communities(ARIC)Study[J].Am J Kidney Dis,2012,60(2):207-16.
[6]Bello A K,Hemmelgarn B,Lloyd A,et al.Associations among estimated glomerular filtration rate,proteinuria,and adverse cardiovascular outcomes[J].CJASN,2011,6(6):1418-26.
[7]G Eknoyan,N W Levin.K/DOQI clinical practice guidelines for chronic kidney disease:Evaluation,classification,and stratificationForeword[J].Am J Kidney Dis,2002,39(2):S14-S266.
[8]李其华,韦金儒,唐泉,等.肾小球滤过率对急性心肌梗死患者直接经皮冠状动脉介入术后预后的影响[J].中国全科医学,2016,19(36):4456-60.
[9]Aissaoui N,Puymirat E,Juilliere Y,et al.Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction:the FAST-MIprogramme[J].EUR J HEART FAIL,2016,18(9):1144-52.
[10]刘莉,叶鹏,Winter MP,等.早发急性心肌梗死的长期结局和风险评估:10年随访研究[J].中华高血压杂志,2017,25(04):311.
[11]Velásquez-Rodríguez J1,Diez-Delhoyo F1,Valero-Masa MJ,et al.Prognostic Impact of Age and Hemoglobin in Acute ST-Segment Elevation Myocardial Infarction Treated With Reperfusion Therapy[J].Am J Cardiol,2017,119(12):1909.
[12]Rifkin DE,Shlipak MG,Katz R,et al.Rapid Kidney Function Decline and Mortality Risk in Older Adults[J].Arch Intern Med,2011,168(20):2212-8.
[13]Arbel Y,Halkin A,Finkelstein A,et al.Impact of estimated glomerular filtration rate on vascular disease extent and adverse cardiovascular events in patients without chronic kidney disease[J].Can J Cardiol,2013,29(11):1374-81.
[14]廖晨军,王秋实,缪绯,等.脑卒中评分在预测冠心病三支血管病变主要不良临床心血管事件中的应用[J].中国急救医学,2016,36(5):424-9.
[15]Chen CL,Yen DHT,Lin CS,et al.Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients:A retrospective observational study[J].Medicine,2017,96(18):e6743.