基础血肌酐正常的急性心肌梗死患者直接经皮冠状动脉介入术后肾功能减退的临床特点

目的 探讨基础血肌酐正常的急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(PCI)术后肾功能减退的临床特点. 方法 根据直接PCI术后是否发生肾功能减退,将216例术前血肌酐正常(＜132.6 μmoL/L)的AMI患者分为肾功能减退组(32例)和非肾功能减退组(184例).比较两组的临床和冠状动脉造影资料,确定肾功能减退的发生率、预测因素及其对治疗和住院期间预后的影响.肾功能减退定义为术后72 h内血肌酐较术前升高≥25%. 结果 直接PCI术后肾功能减退的发生率为14.8%(32/216).肾功能减退组的年龄＞75岁(28.1%比14.1%,P=0.047)、并发心力衰竭(25.0%比9.2%,P=0.017)的患者比例显著高于非肾功能减退组;而低分子肝素(84.4%比95.1%,P=0.039)、β-受体阻滞剂(75.0%比95.6%,P=0.001)、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(81.3%比93.5%,P=0.025)、他汀类药物(84.4%比97.3%,P=0.008)的使用率显著低于非肾功能减退组.肾功能减退组住院期间的死亡率显著高于非肾功能减退组(25.0%比2.2%,P＜0.001).多因素分析显示,并发心力衰竭是发生肾功能减退的惟一独立预测因素比值比(OR)=3.275,95%可信区间1.275～8.408,P=0.014];而肾功能减退是住院期间死亡最强的独立预测因素(OR=10.313,95%可信区间2.569～41.402,P=0.001). 结论 基础血肌酐正常的AMI患者直接PCI术后也易发生肾功能减退.发生肾功能减退者多为AMI的高危患者,治疗不充分,住院期间预后差.

Factors associated with reduced renal function post primary percutaneous coronary intervention in acute myocardial infarction patients with normal baseline serum creatinine level

Objective To analyze factors associated with reduced renal function post primary percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)patients with normal baseline serum creatinine level.Method The clinical and angiographic data of 216 consecutive AMI patients undergoing primary PCI with normal baseline serum creatinine level(<1. 5 mg/dl)were obtained and compared between patients with(n=32)and without(n=184)renal function deterioration(increase in serum creatinine≥25% from baseline level within 72 hours of primary PCI) post PCI.Results The incidence of renal function deterioration was 14.8%(32/216).Patients with age>75 years(28.1%vs.14.1%,P=0.047), congestive heart failure(25.0% vs.9.2%, P=0.017), less use of low-molecular weight heparins(84.4% vs.95.1%,P=0.039)and β-blockers(75.0% vs.95.6%,P=0.001) as well as angiotensin converting enzyme inhibitors/angiotensin receptor blockers(81.3%vs.93.5%,P=0.025)and statins(84.4%vs.97.3%,P=0.008) were risk factors for developing renal dysfunction post PCI.Renal function deterioration post PCI was also associated with increased in-hospital mortality (25.0% vs.2.2%.P<0.001).Multivariate analysis showed that congestive heart failure was the single independent predictor of renal function deterioration(odds ratio=3.275.95% confidence interval 1.275.8.408,P=0.014).while renal function deterioration Was the strongest independent predictor of in-hospital death(odds ratio=10.313,95% confidence interval 2.569-41.402,P=0.001).Conclusion Renal function deterioration is a common complication post primary PCI and is associated with higher risk of in-hospital death in AMI patients with normal baseline serum creatinine level.