慢性肾功能不全对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗预后的影响

目的评价慢性肾功能不全对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)预后的影响。方法回顾性收集因STEMI在北京安贞医院接受急诊PCI的患者743例。将肾小球滤过率(eGFR)<60 mL·min-1·1.73 m-2的患者作为肾功能不全组,eGFR≥60 mL·min-1·1.73 m-2的患者作为对照组,比较2组患者的临床特点、病变特点和预后情况。结果与对照组比较,肾功能不全组患者年龄大、男性少、并发高血压和糖尿病者多、既往心肌梗死病史及多支病变者多、心功能不全(Killip分级≥2)者多(P<0.05);住院期间及随访2 a时主要心血管不良事件及病死率明显升高(P<0.05);Logistic多因素回归分析显示,eGFR<60 mL·min-1·1.73 m-2、年龄≥70岁、Killip分级≥2、糖尿病、既往心肌梗死病史、多支病变均为患者2 a内死亡的独立预测因子(P<0.05),其中eGFR<60 mL·min-1·1.73 m-2校正的相对危险度为1.93(95%可信区间:1.24～4.56,P=0.01)。结论 STE-MI接受急诊PCI治疗患者中,并发肾功能不全患者临床预后较差,而eGFR<60 mL·min-1·1.73 m-2是接受急诊PCI治疗STEMI患者预后不良的最重要危险因素。

Influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention

Objective To evaluate the influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PCI).Methods Data of 743 STEMI patients undergoing primary PCI in Beijing Anzhen hospital were retrospectively collected.Patients were divided into the renal dysfunction group and control group according to estimated glomerular filtration rate(eGFR) < or ≥60 mL·min-1·1.73 m-2.Clinical characteristics,lesion characteristics and prognostic outcomes were compared between the two groups.Results Compared with control group,patients in renal dysfunction group were elder and less male patients,there were more patients with heart failure,hypertension,diabetus mellitus,previous myocardial infarction history,multiple vascular disease and cardiac inadequacy(Killip′s grade≥2)in renal dysfunction group(P<0.05).Major adverse cardiovascular event(MACE) rate and death rate were higher in renal dysfunction group than control group during the period of hospital stay and after following up for 2 years(P<0.05).The results of Logistic multifactor regression analysis showed that,eGFR<60 mL·min-1·1.73 m-2,age≥70 years,Killip′s grade≥2,diabetus mellitus,previous myocardial infarction history and multiple vascular disease were independent predictors of 2-year death(P<0.05),and the corrected relative risk of eGFR<60 mL·min-1·1.73 m-2 was 1.93(95%CI=1.24-4.56,P=0.01).Conclusion Prognosis of STEMI patient undergoing primary PCI combined with chronic renal dysfunction is bad.Estimated GFR<60 mL·min-1·1.73 m-2 is the strongest risk factor for unfavourable prognosis of the STEMI patients who undergo primary PCI.