肾功能不全与高龄冠脉支架治疗的预后分析

目的 探讨不同肾功能对高龄冠心病患者经皮冠状动脉支架治疗住院期间和长期预后的影响.方法 回顾性分析90例85岁以上冠心病接受冠脉支架治疗患者主要心血管不良事件和病死率.根据入院时估算的肾小球滤过率水平,患者分为eGFR≥60组（肾功能正常或轻度不全组;n=62）和eGFR〈60组（中重度肾功能不全组;n=28）,观察肾功能不全对高龄冠脉介入治疗预后的影响.结果 eGFR〈60组高血压病、目前吸烟状态、既往心肌梗死病史、三支病变、C型病变、术前TIMI0级血流比例略高.住院期间主要心血管不良事件发生率eGFR〈60组要明显高于eGFR≥60组（14.3%vs4.8%;P〈0.05）.随访1年时全因死亡率两组相似（4.9%vs4.0%;P〉0.05）,但MACE发生率eGFR〈60组仍高于eGFR≥60组（8.0%vs3.3%;P＝0.05）.整体研究人群1年生存率较高.结论 中重度肾功能不全是影响高龄冠脉支架治疗预后的一个重要危险因素,围手术期应积极地改善患者的肾功能从而改善预后.

Prognostic analysis of renal insufficiency in octogenarian patients underwent percutaneous coronary stenting

Objective To evaluate the effect of renal insufficiency on short and long term prognosis and major adverse cardiac event （MACE） in octogenarian patients undergoing percutaneous coronary intervention （PCI）. Methods A total of 90 patients aged 85 years and over with coronary heart disease （CAD） undergoing stenting were enrolled in this study. The all-cause mortality, MACE, stroke and other major bleeding were collected and analyzed. Based on estimated glomerular filtration rate level, patients were divided into two groups, estimated glomerular filtration rate〈60ml/min （moderate to severe renal insufficiency group; n=28） and estimated glomerular filtration rate≥60ml/min （normal/minimal renal insufficiency group; n=62）. Results Patients in moderate to severe renal insufficiency group were more likely to be a current smoker or to have hypertension and a history of MI. Except three vessel lesion, type-e lesion and preoperative TIMI zero grade flow, angiographic and procedure characteristics were similar between the two groups. Patients who were in moderate to severe renal insufficiency group had a significantly higher in-hospital MACE rate （14.3% vs 4.8%; P〈0.05）. During one year follow up, all-cause mortality was similar （4.9% vs. 4.0%;P〉0.05） but MACE （8.0% vs. 3.3%; P=0.05） was still higher in moderate to severe renal insufficiency group than that in normal/minimal renal insufficiency group. However, the one year survivor rate （95.3%） was high among the whole group. Conclusion Moderate to severe renal insufficiency is an important clinical risk factor that will affect the MACE in octogenarian patients underwent PCI.