STEMI行急诊PCI术患者V/eGFR对对比剂肾病和近期预后的影响

目的:评估对比剂用量与估算的肾小球滤过率比值(V/eGFR)对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入(PCI)术后对比剂肾病(CIN)发生率和近期(住院期间)预后的影响?方法:连续入选215例急性ST段抬高型心肌梗死行急诊PCI患者,计算所有患者eGFR值,通过ROC曲线确立V/eGFR对CIN的预测价值,并应用多元回归分析评估CIN风险?结果:所有患者CIN发生率为11.6%(25例),V/eGFR是CIN显著的危险因素,应用ROC曲线分析显示,当V/eGFR > 2.45时与CIN及住院期间不良预后密切相关(OR = 4.15,95%CI:1.19~13.56,P = 0.025)?结论:急性ST段抬高型心肌梗死患者V/eGFR > 2.45是急诊PCI术后发生CIN和住院期间预后不良的最佳预测值?

Effects of the ratio between contrast volume and eGFR for development of CIN and in-hospital prognosis in patients with STEMI undergoing primary PCI

Objective:To assess the effect of the ratio between contrast medium volume and eGFR for prediction of development of contrast-induced nephropathy (CIN) and the in-hospital prognosis in patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Method:The study included 215 consecutive patients with STEMI without cardiogenic shock who underwent primary PCI from January 1,2013 to December 4,2013. We calculated their ratio of contrast volume to estimated glomerular filtration rate.ROC methods were used to identify the optimal value of V/eGFR for CIN. The predictive value of V/eGFR was established by Roc curve,and the risk of CIN was assessedusing multivariable logistic regression. Results:Twenty-five(11.6%) patients developed CIN after PCI.V/eGFR is a significantly risk factor of CIN. The ROC curve analysis indicated that a V/eGFR ratio of 2.45 was a fair discriminator for CIN,and a V/eGFR ratio > 2.45 remained significantly associated with CIN (OR 4.15,95%CI 1.19-13.56,P = 0.025). Conclusion:A V/eGFR ratio > 2.45 was a significant predictor of CIN and a poor prognosis in hospital after primary PCI in patients with STEMI.