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首页> 外文期刊>The American Journal of Cardiology >Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment
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Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment

机译：接受原发性经皮冠状动脉介入治疗而没有急性左心室射血分数损害的患者的造影剂肾病

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摘要

The prognostic relevance of direct contrast toxicity in patients treated with primary percutaneous coronary intervention remains unclear, owing to the confounding hemodynamic effect of acute left ventricular ejection fraction (LVEF) impairment on kidney function estimation. In the present study, 644 consecutive patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were prospectively enrolled. Contrast-induced nephropathy (CIN) was defined as an increase in serum creatinine >25% or a decrease in the estimated glomerular filtration rate (eGFR) <25% from baseline in the first 72 hours. The primary end point of the study was major adverse cardiovascular events at 1 year (composite of death, myocardial infarction, target lesion revascularization, and bleeding). Among the global population, the interaction between the LVEF and eGFR at admission to define CIN was statistically significant (p <0.001). When only the 385 patients without acute LVEF impairment (i.e., those with LVEF ??40%) were considered, 27 (7%) developed postprocedural CIN that was associated with increased major adverse cardiovascular events rate at 1 year of clinical follow-up (38% vs 9%; p <0.001). On adjusted Cox multivariate analysis, CIN was an independent predictor of worse outcomes, both when defined according to creatinine (hazard ratio 3.81, 95% confidence interval 1.71 to 8.48, p = 0.001) or eGFR (hazard ratio 3.77, 95% confidence interval 1.53 to 9.28, p = 0.004) variations. In conclusion, in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, LVEF has a significant interaction with eGFR. When only patients without acute LVEF impairment were considered, CIN confirmed its negative prognostic effect on the 1-year clinical outcomes. ? 2013 Elsevier Inc. All rights reserved.
机译：由于急性左心室射血分数（LVEF）损害对肾功能评估的混杂血流动力学影响，在直接经皮冠状动脉介入治疗的患者中，直接对比毒性的预后相关性尚不清楚。在本研究中，前瞻性纳入了连续644例ST段抬高型心肌梗死患者，这些患者均接受了原发性经皮冠状动脉介入治疗。造影剂诱发的肾病（CIN）被定义为在最初72小时内，血清肌酐增加> 25％或肾小球滤过率估计值（eGFR）相对于基线下降<25％。该研究的主要终点是1年时的主要不良心血管事件（死亡，心肌梗塞，目标病变血运重建和出血的复合）。在全球人群中，入院时LVEF和eGFR之间的相互作用定义了CIN，具有统计学意义（p <0.001）。当仅考虑无急性LVEF损害的385例患者（即LVEF≥40％的患者）时，有27例（7％）发生了术后CIN，这与临床随访1年时的主要不良心血管事件发生率增加相关（ 38％和9％; p <0.001）。根据校正的Cox多变量分析，当根据肌酐（危险比3.81，95％置信区间1.71至8.48，p = 0.001）或eGFR（危险比3.77，95％置信区间1.53）定义时，CIN是不良结局的独立预测因子。至9.28，p = 0.004）变化。总之，在ST段抬高型心肌梗死患者中，经原发性经皮冠状动脉介入治疗时，LVEF与eGFR有显着相互作用。仅考虑无急性LVEF障碍的患者时，CIN证实了其对1年临床预后的负面预后作用。 ？ 2013 Elsevier Inc.保留所有权利。

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