年龄对急性ST段抬高型心肌梗死患者急诊行经皮冠状动脉介入治疗术后发生对比剂诱发的急性肾损伤的影响

Influence of age on contrast-induced acute kidney injury in acute ST-segment elevation myocardial infarction patients after emergency percutaneous coronary intervention

摘要:

目的 探讨不同年龄对急性ST段抬高型心肌梗死患者急诊行经皮冠状动脉介入治疗（PCI）术后，发生对比剂诱发的急性肾损伤（CI-AKI）的影响。方法 回顾性分析2006年2月至2012年9月期间在沈阳军区总医院心内科监护病房住院的急性ST段抬高型心肌梗死且急诊行PCI术的患者1 685例。按年龄分为两组：＜60岁组（n＝932）和≥60岁组（n＝753）。比较两组患者的临床资料，对单因素分析有统计学意义的指标进行多因素logistic 回归分析，筛选出独立的危险因素。同时观察术后1个月、6个月、1年及3年两组患者发生主要心脏不良事件（MACE）和全因死亡的相关情况。结果 ≥60岁组患者CI-AKI发病率高于＜60岁组患者（14.7% vs 8.6%，P＜0.001）。年龄、既往心肌梗死病史和对比剂剂量是CI-AKI发生的危险因素。术后3年，≥60岁组患者的累积全因死亡率和心源性死亡率均明显高于＜60岁组患者（4.2% vs 1.5%，P＜0.001；1.5% vs 0.2%，P＝0.011）。结论 临床医师应慎重对待高龄患者，在术前充分评估患者心功能，在术中尽量精准使用对比剂剂量，以期预防CI-AKI的发生。

Abstract:

Objective To determine the influence of different ages on the incidence of contrast-induced acute kidney injury (CI-AKI) in acute ST-segment elevation myocardial infarction patients after undergoing emergency percutaneous coronary intervention (PCI). Methods A retrospective study was carried out on 1 685 ST-segment elevation acute myocardial infarction patients undergoing emergency PCI and stent implantation in the ICU of our department from February 2006 to September 2012. They were divided into the ＜60 years old group (n＝932) and the ≥60 years old group (n＝753). The clinical data were compared between the 2 groups. Multivariate logistic regression analysis was used to detect the significant indicators obtained by univariate analysis to screen independent risk factors. The occurrences of major adverse cardiovascular events (MACE) and all-cause mortality were observed in 1 and 6 months, and 1 and 3 years after surgery. Results The incidence of CI-AKI was significantly higher in the ≥60 years old group than in the ＜60 years old group (14.7% vs 8.6%, P＜0.001). Age, previous myocardial infarction, and volume of contrast were independent risk factors for CI-AKI. During the 3 years’ follow-up after PCI, the cumulative all-cause mortality and cardiac mortality were significantly higher in the ≥60 years old group than in the ＜60 years old group (4.2% vs 1.5%, P＜0.001; 1.5% vs 0.2%, P＝0.011). Conclusion Clinicians should treat the elderly patients with caution, and fully assess their preoperative cardiac function and precisely determine contrast volume to prevent the occurrence of CI-AKI.