2022 年第 4 期 第 17 卷

慢性肾脏病对行经皮冠状动脉介入术高龄冠心病患者预后的影响

Effect of chronic kidney disease on outcomes in octogenarians with coronary atherosclerotic heart disease undergoing percutaneous coronary intervention

作者：胡宾贾硕成万钧杨士伟贾德安翟光耀王建龙刘宇扬史冬梅周玉杰

英文作者：Hu Bin Jia Shuo Cheng Wanjun Yang Shiwei Jia Dean Zhai Guangyao Wang Jianlong Liu Yuyang Shi Dongmei Zhou Yujie

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心,北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Heart Disease Clinical Center for Coronary Atherosclerotic Heart Disease Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；经皮冠状动脉介入；慢性肾脏病

英文关键词：Coronaryatheroscleroticheartdisease;Percutaneouscoronaryintervention;Chronickidneydisease

• 摘要：

• 目的探讨慢性肾脏病（CKD）对行经皮冠状动脉介入（PCI）术高龄冠心病（冠状动脉粥样硬化性心脏病）患者预后的影响。方法回顾性分析2016年1月至2018年12月在首都医科大学附属北京安贞医院成功行PCI术且完成随访的536例≥80岁冠心病患者的临床资料和随访资料。根据患者术前估算肾小球滤过率(eGFR)分为2组：观察组eGFR＜60 ml/(min·1.73 m2)，199例；对照组eGFR≥60 ml/(min·1.73 m2)，337例。eGFR＜60 ml/(min·1.73 m2)定义为CKD。比较2组性别、年龄、合并症、冠心病家族史、既往史、心功能和应用药物情况等术前基线临床资料，以及术后主要不良心血管事件（MACE）包括全因死亡、心肌梗死和靶血管再次血运重建(TVR)发生情况，分析CKD对预后的影响。结果观察组年龄，合并高血压病、糖尿病、吸烟，既往心肌梗死史、脑卒中史和左心室射血分数＜50%比例均高于对照组（均P＜0.05），2组男性、血脂异常、冠心病家族史、PCI史、冠状动脉旁路移植史和应用药物情况比较差异均无统计学意义（均P＞0.05）。术后随访（22±5）个月，观察组MACE、全因死亡、TVR发生率均高于对照组［27.6%(55/199)比14.0%（47/337）、16.1%(32/199)比5.3%（18/337）、13.6%(27/199)比6.2%（21/337）］（均P＜0.05），2组心肌梗死发生率比较差异无统计学意义（P＞0.05）。Cox回归分析结果显示，调整了性别、年龄、合并症、冠心病家族史、既往史、心功能和应用药物情况后，CKD仍为接受PCI高龄冠心病患者术后发生MACE（比值比=1.517，95%置信区间：1.005~2.289，P=0.047）、全因死亡（比值比=2.094，95%置信区间：1.147~3.821，P=0.016）和TVR（比值比=2.098，95%置信区间：1.176~3.745，P=0.013）的独立危险因素，但不是发生心肌梗死的影响因素(P＞0.05)。结论CKD是行PCI术高龄冠心病患者预后不良的独立影响因素。

• ObjectiveTo evaluate the effect of chronic kidney disease (CKD) on outcomes of octogenarians with coronary atherosclerotic heart disease undergoing percutaneous coronary intervention (PCI). MethodsThe clinical data and follow-up data of 536 octogenarians with coronary atherosclerotic heart disease who underwent PCI successfully in Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2018 were retrospectively analyzed. According to the level of preoperative estimated glomerular filtration rate (eGFR), patients were divided into two groups. The observation group contained 199 patients with eGFR <60 ml/(min·1.73 m2) and the control group contained 337 patients with eGFR ≥ 60 ml/(min·1.73 m2). CKD was defined as eGFR＜60 ml/(min·1.73 m2). The preoperative clinical data such as gender, age, complications, family history of coronary atherosclerotic heart disease, previous history, cardiac function and drug application, as well as the postoperative main adverse cardiovascular events (MACE), including all-cause death, myocardial infarction and target vessel revascularization (TVR) were compared between the two groups. The impact of CKD on patients′ prognosis was analyzed. ResultsThe age, proportions of hypertension, diabetes mellitus, smoking, myocardial infarction history, stroke history and left ventricular ejection fraction＜50% in the observation group were higher than those in the control group (all P＜0.05). There were no significant differences in male, dyslipidemia, family history of coronary atherosclerotic heart disease, PCI history, coronary artery bypass grafting history and drug application between the two groups (all P>0.05). After followed-up for (22±5)months, the incidences of MACE, all-cause death and TVR in the observation group were higher than those in the control group ［27.6%(55/199) vs 14.0%(47/337), 16.1%(32/199) vs 5.3%(18/337), 13.6%(27/199) vs 6.2%(21/337)］ (all P＜0.05). There was no significant difference in the incidence of myocardial infarction between the two groups (P>0.05). Cox regression analysis showed that after adjusting gender, age, complications, family history of coronary atherosclerotic heart disease, previous history, cardiac function and drug application, CKD was still the independent risk factor for MACE (odds ratio=1.517, 95% confidence interval: 1.005-2.289, P=0.047), all-cause death (odds ratio=2.094, 95% confidence interval: 1.147-3.821, P=0.016) and TVR (odds ratio=2.098, 95% confidence interval: 1.176-3.745, P=0.013) in octogenarians with coronary atherosclerotic heart disease after PCI, however, it was not a factor for myocardial infarction (P>0.05). ConclusionCKD is an independent factor affecting the poor outcomes of octogenarians with coronary atherosclerotic heart disease after PCI.