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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

28卷

期数:

2022年06期

页码:

636-642

栏目:

临床医学

出版日期:

2022-11-20

文章信息/Info

Title:

Prognostic impact of chronic kidney disease on elderly patients undergoing percutaneous coronary intervention

文章编号:

1006-8147(2022)06-0636-07

作者:

张雪¹; 郭少华¹; Rha Seungwoon²; 陈康寅¹

1.天津医科大学第二医院心脏科，天津市心血管病离子与分子机能重点实验室，天津心脏病学研究所，天津 300211； 2. 韩国高丽大学附属九老医院心脏中心， 首尔 999007

Author(s):

ZHANG Xue¹; GUO Shao-hua¹; Rha Seungwoon²; CHEN Kang-yin¹

（1.Department of Cardiology，The Second Hospital，Tianjin Medical University，Tianjin Key Laboratory Ionic-Molecular Function of Cardiovascular Disease，Tianjin Institute of Cardiology，Tianjin 300211，China；2.Korea University Guro Hospital，Seoul，Republic of Korea，Seoul 999007，Korea）

关键词:

慢性肾脏病; 冠状动脉介入治疗; 老年患者; 主要心血管不良事件

Keywords:

chronic kidney disease;  percutaneous coronary intervention;  old age;  prognosis

分类号:

R543.3

DOI:

-

文献标志码:

A

摘要:

目的：评估慢性肾脏病（CKD）对老年患者接受冠脉介入（PCI）治疗预后的影响。方法：连续入选2004年1月—2017年12月行PCI术的年龄在60岁以上且有基线血肌酐值的患者2 681例，分为CKD组和非CKD组。CKD的定义为根据（MDRD）公式得出的估算肾小球滤过率（eGFR）<60 mL/（min·1.73 m2）。将肾小球滤过率（eGFR）>60 mL/（min·1.73 m2）的2 148例患者作为非CKD组，将肾小球滤过率<60 mL/（min·1.73 m2）的533例患者作为CKD组，收集患者基线临床资料，随访3年，以主要不良心血管事件（MACE）作为主要临床终点。结果：与非CKD组相比，CKD组女性行PCI比例更高（χ2=44.207，P<0.001），年龄更大（t=3.763，P<0.001），高血压（χ2=31.540，P<0.001）、糖尿病（χ2=57.054，P<0.001）、既往心肌梗死（χ2=4.553，P=0.033）、既往经皮冠状动脉成形术（PTCA）（χ2=4.763，P=0.029）、既往脑血管意外（χ2=18.029，P<0.001）、心源性休克（χ2=32.552，P<0.001）、ST段抬高型心肌梗死（STEMI）（χ2=4.784，P=0.029）、非ST段抬高型心肌梗死（NSTEMI）比例更高（χ2=7.678，P=0.006），左室射血分数处于更低水平（t=7.396，P<0.001），老年CKD患者左主干（χ2=9.925，P=0.002）、右冠状动脉（χ2=4.572，P=0.032）、多血管病变（χ2=6.173，P=0.013）行PCI比例更高，主要临床终点事件MACE发生率显著增加（HR=2.11，95%CI：1.68～2.66，P<0.001），次要终点事件心源性死亡（CD）发生率增加（HR=5.29，95%CI：3.66～7.66，P<0.001），其余终点事件无统计学差异（均P>0.05）。倾向性评分匹配及倾向性评分逆概率加权法后，CKD组MACE及CD发生率较非CKD组仍增加，与匹配前结果一致。结论：CKD显著增加老年患者心血管不良事件发生风险。

Abstract:

Objective： To assess the prognostic impact of chronic kidney disease（CKD） on elderly patients undergoing percutaneous coronary intervention（PCI）. Methods: A total of 2 681 consecutive elderly patients over 60 years old with baseline blood creatinine who underwent PCI from January 2004 to December 2017 were enrolled，and divided into CKD group and non-CKD group. CKD was defined as the estimated glomerular filtration rate（eGFR）<60 mL/（min·1.73 m2）according to the formula of modification of diet inrenal disease（MDRD）. 2 148 patients with glomerular filtration rate（eGFR）>60 mL/（min·1.73 m2） were included in the non-CKD group，and 533 patients with glomerular filtration rate <60 mL/（min·1.73 m2） were included in the CKD group. Baseline clinical data of patients were collected. The primary end point was major adverse cardiovascular events（MACE） at three years. Results: Compared with non-CKD group，women in the CKD group had higher rates（χ2=44.207，P<0.001），CKD group had higher age（t=3.763，P<0.001），higher proportion of hypertension（χ2=31.540，P<0.001），diabetes（χ2=57.054，P<0.001），previous cerebrovascular accident（χ2=18.029，P<0.001），previous myocardial infarction（χ2=4.553，P=0.033），previous percutaneous transluminal coronary angioplasty（PTCA）（χ2=4.763，P=0.029），cardiogenic shock（χ2=18.029，P<0.001），ST-segment elevation myocardial infarction（STEMI）（χ2=4.784，P=0.029），non-ST-segment elevation myocardial infarction（NSTEMI）（χ2=7.678，P=0.006），lower left ventricular ejection fraction（t=7.396，P<0.001）.Besides，in elderly CKD patients，left main coronary artery disease（χ2=9.925，P=0.002），right coronary artery（χ2=4.572，P=0.032） and multivessel disease（χ2=6.173，P=0.013） was more frequent. The incidence of primary clinical end point MACE was significantly increased（MACE：HR=2.11，95%CI：1.68-2.66，P<0.001），as well as incidence of secondary end points cardiac death（CD） was significantly increased（CD：HR=5.29，95%CI：3.66-7.66，P<0.001），and there was no significant difference in other end points（P>0.05）. After propensity score matching and propensity score inverse probability weighting，the increased incidence of MACE and CD in CKD group compared with non-CKD group were further confirmed by PSM and IPTW. Conclusion: CKD significantly increases the risk of cardiovascular adverse events in older patients.

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备注/Memo

备注/Memo:

基金项目 天津市医学重点学科（专科）建设项目（2021）
作者简介 张雪（1995-），女，,硕士在读，研究方向：冠心病临床研究；
通信作者：陈康寅，E-mail： chenkangyin@vip.126.com。

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更新日期/Last Update: 2022-11-20