分期冠状动脉介入治疗的间隔时间对老年患者肾功能的影响

目的探讨分期冠状动脉介入(PCI)治疗的不同间隔时间对老年患者肾功能的影响。方法对2014年1月至2016年6月在辽宁省人民医院进行分期PCI的417例不稳定型心绞痛(UA)或急性非ST段抬高型心肌梗死(NSTEMI)老年冠状动脉多支血管病变(MVD)患者进行回顾性分析。其中,早期再次介入组(A组)172例,两次介入治疗间隔3~7d;晚期再次介入组(B组)245例,间隔时间15~30d。记录两组患者基本临床资料、两次PCI术前与术后3d血清肌酐值(SCr),计算对比剂导致的急性肾损伤(CI-AKI)风险评分、肾小球滤过率估测值(eGFR),检测有无CI-AKI,比较两组患者肾功能。采用SPSS 15.0进行统计分析。计量资料和计数资料组间比较分别采用t检验和X~2检验。结果两组患者基线临床资料差异无统计学意义(P0.05);两次PCI术前术后SCr、eGFR差异均无统计学意义(P0.05);A组发生CI-AKI 5例(2.90%),B组6例(2.45%),两组比较差异无统计学意义(P=0.77);住院期间无紧急透析、新发急性心肌梗死、急性脑卒中、紧急血运重建及死亡等严重不良事件。结论对于CI-AKI风险评分低中危、进行分期PCI的老年MVD患者,不同的间隔时间对其肾功能的影响无明显差异,早期再次PCI是安全可行的。

Impact of different time interval of staged percutaneous coronary intervention on renal function of elderly patients

Objective To evaluate the impact of different time interval of staged percutaneous coronary intervention(PCI) on renal function of elderly patients. Methods Totally 417 elderly of multivessel disease (MVD) patients with unstable angina(UA)or non-ST segment elevation myocardial infarction(NSTEMI), who received staged PCI from January 2014 to June 2016,were analyzed retrospectively. They were divided into the short interval group (n=172) and the long interval group (n=245) by the time interval of staged PCI. The clinical data were recorded including age, gender, body mass, serum creatinine (SCr) before and after PCI. Body mass index(BMI), the risk score for prediction of contrast-induced acute kidney injury(CI-AKI),and the estimated glomerular filtration rate(eGFR) were obtained. Renal function in patients of the two groups was statistically analyzed. SPSS statistics 15.0 was used to perform the statistical analysis. Measurement data and enumeration data were compared with t test or Chi-square test respectively. Results The clinical data including age, gender, BMI, SCr and the risk score for prediction of CI-AKI were not significantly different between the two groups before PCI(P>0.05). There was no statistical difference of renal function in the two groups before and after PCI(P>0.05), neither in the incidence of CI-AKI between two groups (2.90% in the short interval group versus 2.45% in the long interval group, P=0.77). No serious adverse events, such as emergency dialysis, new-onset acute myocardial infarction, acute stroke, emergency revascularization, or death, was reported during hospitalization. Conclusion The difference in time intervals of staged PCI has no obvious impact on renal function of elderly MVD patients with UA/NSTEMI. It is safe and feasible for patients with low or moderate risk of CI-AKI to undergo staged PCI after a short time interval.