経皮冠動脈介入後の急性腎不全の発生率と予後的重要性
Charanjit S Rihal1, Stephen C Textor, Diane E Grill
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Circulation
|May 16, 2002
まとめ
経皮冠動脈干渉 (PCI) 後の急性腎不全 (ARF) は珍しいが,死亡率を大幅に増加させる. 発症時のクレアチニン値 <2.0 mg/dL の糖尿病患者および発症時のクレアチニン値 >2.0 mg/dL のすべての患者は,より高いARFリスクに直面します.
科学分野:
- 心臓病学 心臓病学
- ネフロロジーはネフロロジーを用います.
- 介入性心臓病学 介入性心臓病学
背景:
- 経皮冠動脈干渉 (PCI) の後の急性腎不全 (ARF) の発生率と予後の影響は,現代の実践では不明のままである.
- ARFのリスクを理解することは,PCI後の患者管理と結果にとって極めて重要です.
研究 の 目的:
- PCI後のARFの発生率,危険因子,および予後的影響を決定する.
- ARFのリスクが高い患者のサブグループを特定する.
主な方法:
- メイオ・クリニックのPCIレジストリの遡及的分析.
- PCIを受けている7586人の患者が含まれています.
- ARFの定義は,血清クレアチニン値がベースラインから>0.5 mg/dL増加である.
主要な成果:
- ARFは患者の3.3% (254/7586) で発生しました.
- リスク要因には,ベースラインの血清クレアチニン,急性心筋梗塞,ショック,コントラスト量が含まれていました.
- ベースラインのクレアチニン値 <2.0 mg/dLの糖尿病患者はARFのリスクが高く,ベースラインのクレアチニン値 >2.0 mg/dLのすべての患者は高リスクであった.
- ARFは,入院 (22%対1.4%) と長期死亡率 (1年:12.1%対3.7%;5年:44.6%対14.5%) の有意な増加と関連していました.
結論:
- PCI後のARFの全体的な発生率は低い.
- ベースラインクレアチニン<2.0 mg/dLの糖尿病患者およびベースラインクレアチニン>2.0 mg/dLのすべてを含む特定の患者グループは,リスクが高いです.
- ARFは,入院および長期追跡中の死亡率の強い予測因子である.
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