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首页> 外文期刊>JACC. Cardiovascular interventions >Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial.
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Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial.

机译：慢性肾脏疾病对原发性经皮冠状动脉介入治疗ST段抬高型心肌梗死患者的长期影响：HORIZONS-AMI（在急性心肌梗死中与血运重建术和支架相结合的结果）试验。

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OBJECTIVES: This study sought to investigate the impact of chronic kidney disease (CKD) in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) with different antithrombotic strategies. BACKGROUND: CKD is associated with increased risk of adverse ischemic and hemorrhagic events after primary PCI for STEMI. METHODS: HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial was a multicenter, international, randomized trial comparing bivalirudin monotherapy or heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) during primary PCI in STEMI. CKD, defined as creatinine clearance <60 ml/min, was present at baseline in 554 of 3,397 patients (16.3%). Patients were followed for 3 years. Net adverse cardiac event (NACE) was defined as the composite of death, reinfarction, ischemia-driven target vessel revascularization (TVR), stroke or non-coronary artery bypass grafting (CABG)-related major bleeding. RESULTS: Patients with CKD compared with patients without had higher rates of NACE (41.4% vs. 23.8%, p < 0.0001), death (18.7% vs. 4.4%, p < 0.0001), and major bleeding (19.3% vs. 6.7%, p < 0.0001). Multivariable analysis identified baseline creatinine as an independent predictor of death at 3 years (hazard ratio: 1.51, 95% confidence interval: 1.21 to 1.87, p < 0.001). Patients with CKD randomized to bivalirudin monotherapy versus heparin plus GPI had no significant difference in major bleeding (19.0% vs. 19.6%, p = 0.72) or death (19.0% vs. 18.4%, p = 0.88) at 3 years. In patients with CKD, there was no difference in the rates of TVR in bare-metal stents (BMS) versus drug-eluting stents (DES) at 3 years (14.1% vs. 15.1%, p = 0.8). CONCLUSIONS: STEMI patients with CKD have significantly higher rates of death and major bleeding compared with those without CKD. In patients with CKD, there appears to be no benefit of bivalirudin compared with heparin + GPI, or DES versus BMS during primary PCI in improving clinical outcomes.
机译：目的：本研究旨在探讨慢性肾脏病（CKD）对接受不同抗栓治疗策略的ST段抬高型心肌梗死（STEMI）的经皮冠状动脉介入治疗（PCI）患者的影响。背景：CKD与STEMI的原发PCI后不良缺血和出血性事件的风险增加有关。方法：HORIZONS-AMI（在急性心肌梗死中与血运重建和支架相适应的结果）试验是一项多中心，国际，随机试验，比较了在STEMI的原发性PCI中使用比伐卢定单药或肝素加糖蛋白IIb / IIIa抑制剂（GPI）的情况。 CKD（定义为肌酐清除率<60 ml / min）在3,397例患者中的554例中占基线（16.3％）。患者被随访3年。净心脏不良事件（NACE）定义为死亡，再梗死，局部缺血驱动的靶血管血运重建（TVR），中风或非冠状动脉搭桥术（CABG）相关的主要出血的复合物。结果：CKD患者与未患CKD的患者相比，NACE发生率更高（41.4％vs. 23.8％，p <0.0001），死亡（18.7％vs. 4.4％，p <0.0001）和大出血（19.3％vs. 6.7） ％，p ＜0.0001）。多变量分析确定基线肌酐是3年时死亡的独立预测因子（危险比：1.51，95％置信区间：1.21至1.87，p <0.001）。 CKD患者随机接受比伐卢定单药治疗与肝素加GPI治疗在3年时的大出血（19.0％vs. 19.6％，p = 0.72）或死亡（19.0％vs. 18.4％，p = 0.88）方面无显着差异。 CKD患者在3年时裸金属支架（BMS）与药物洗脱支架（DES）的TVR率无差异（14.1％对15.1％，p = 0.8）。结论：与没有CKD的患者相比，患有CKD的STEMI患者的死亡率和严重出血率要高得多。对于CKD患者，在主要PCI期间，比伐卢定与肝素+ GPI或DES与BMS相比没有任何益处，以改善临床疗效。

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