摘要
目的 探讨经皮冠状动脉介入治疗（PCI）在急性冠状动脉综合征（ACS）合并慢性肾脏病患者中应用的安全性.方法 回顾性分析2011年1月至2014年5月在北京朝阳医院治疗的335例ACS合并慢性肾脏病患者的临床资料.根据住院期间是否接受PCI,将患者分为PCI组（n=135）和保守治疗组（n=200）.采用多因素logistic回归分析PCI与患者院内病死率及院内肾功能恶化率的关系.结果 335例患者的肾小球滤过率（GFR）中位数为36.26（25.09 ～47.65）ml· min-1·1.73 m-2.PCI组与保守治疗组患者的GFR差异无统计学意义（P =0.205）.多因素logistic回归分析显示,PCI组与保守治疗组相比院内病死率（OR=0.465,95％CI：0.190 ～1.136,P=0.093）和院内肾功能恶化率（OR =0.830,95％ CI：0.375～1.836,P=0.669）差异均无统计学意义;在45 ml·min-1·1.73 m-2≤GFR ＜60 ml·min-1·1.73 m-2、30 ml·min-1· 1.73 m-2≤GFR ＜45 ml·min-1· 1.73 m-2和GFR ＜30 ml·min-1·1.73 m-2的患者中,PCI组与保守治疗组相比院内病死率差异无统计学意义[OR值分别为0.235（95％CI：0.024 ～2.301,P=0.213）、0.640（95％ CI：0.112 ～3.649,P=0.616）和0.919（95％CI：0.159 ～ 5.307,P=0.925）],院内肾功能恶化率差异也无统计学意义[OR值分别为0.436（95％ CI：0.120 ～1.587,P=0.208）、2.209 （95％ CI：0.394 ～ 12.391,P=0.368）和0.724（95％CI：0.127 ～4.117,P=0.716）].结论 对于合并慢性肾脏病的ACS患者,PCI不增加其院内死亡及肾功能恶化的风险.
Objective To evaluate the safety of percutaneous coronary intervention （PCI） in patients with acute coronary syndromes （ACS） complicating chronic kidney disease （CKD）.Methods We retrospectively evaluated the medical data of 335 patients hospitalized in our hospital with a diagnosis of ACS and CKD between 1 January 2011 and 30 May 2014.Patients were divided into two groups： PCI group who received PCI treatment during hospitalization （n =135） and non-PCI group who did not receive PCI treatment （n =200）.Multivariable logistic regression analysis was performed to evaluate the connection between PCI and in-hospital death and acute renal insufficiency.Results The median GFR level of 335 patients was 36.26 （25.09-47.65） ml ＆#183; min-1 ＆#183; 1.73 m-2.GFR level was similar between the two groups （P =0.205）.Multivariable logistic regression analysis showed that PCI did not increase the risk of inhospital death （OR =0.465,95% CI：0.190-1.136, P =0.093） and in-hospital acute renal insufficiency （OR =0.830,95% CI：0.375-1.836, P =0.669）.In patients of 45 ml ＆#183; min-1 ＆#183; 1.73 m-2 ≤ GFR 〈 60 ml ＆#183; min-1 ＆#183; 1.73 m-2, 30 ml ＆#183; min-1 ＆#183; 1.73 m-2≤GFR 〈45 ml ＆#183; min-1 ＆#183; 1.73 m-2 and GFR 〈30 ml ＆#183; min-1 ＆#183; 1.73 m-2, the OR of in-hospital death in PCI group were 0.235 （95% CI：0.024-2.301 ,P =0.213）, 0.640（95% CI：0.112-3.649,P =0.616）and 0.919（95% CI：0.159-5.307,P =0.925） ,and the OR of in-hospital acute renal insufficiency were 0.436 （95% CI： 0.120-1.587, P =0.208）, 2.209 （95 % CI： 0.394-12.391, P =0.368） and 0.724 （95 % CI： 0.127-4.117, P =0.716） indicating that PCI did not increase above events in ACS patients complicating CKD.Conclusion PCI does not increase the risk of in-hospital death and in-hospital acute renal insufficiency in ACS patients complicating CKD.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2015年第10期848-853,共6页
Chinese Journal of Cardiology
关键词
冠状动脉疾病
肾疾病
血管成形术
经腔
经皮冠状动脉
Coronary disease
Kidney diseases
Angioplasty,transluminal,percutaneous coronary
