Prognostic Value of Incomplete Revascularization after Percutaneous Coronary Intervention Following Acute Coronary Syndrome: Focus on CKD Patients

被引：17

作者：

Cardi, Thomas ^{[1
]}

Kayali, Anas ^{[1
]}

Trimaille, Antonin ^{[1
]}

Marchandot, Benjamin ^{[1
]}

Ristorto, Jessica ^{[1
]}

Viet Anh Hoang ^{[1
,2
]}

Hess, Sebastien ^{[1
]}

Kibler, Marion ^{[1
]}

Jesel, Laurence ^{[1
,3
]}

Ohlmann, Patrick ^{[1
]}

Morel, Olivier ^{[1
,3
]}

机构：

[1] Univ Strasbourg, Ctr Hosp Univ, Nouvel Hop Civil, Pole Act Medicochirurg Cardiovasc, F-67090 Strasbourg, France

[2] Bach Mai Hosp, Vietnam Natl Heart Inst, 78 Giai Phong, Hanoi 10000, Vietnam

[3] Univ Strasbourg, Fac Med, Regenerat Nanomed, UMR 1260,INSERM French Natl Inst Hlth & Med Res,F, 11 Rue Humann, F-67085 Strasbourg, France

来源：

JOURNAL OF CLINICAL MEDICINE | 2019年 / 8卷 / 06期

关键词：

chronic kidney disease; SYNTAX score; residual SYNTAX score; incomplete revascularization; coronary artery disease; CHRONIC KIDNEY-DISEASE; ELEVATION MYOCARDIAL-INFARCTION; RESIDUAL SYNTAX SCORE; DRUG-ELUTING STENTS; CARDIOVASCULAR MORTALITY; MULTIVESSEL DISEASE; P2Y(12) INHIBITION; ARTERY-DISEASE; IMPACT; OUTCOMES;

D O I：

10.3390/jcm8060810

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Background: Residual coronary artery disease (CAD) has been associated with worsened prognosis in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). The residual SYNTAX Score (rSS) aims to assess residual CAD after PCI. The association between kidney function and rSS has not been investigated in ACS patients. In this study, we sought to determine whether chronic kidney disease (CKD) patients exhibit more incomplete revascularization following stage revascularization procedures by PCI. We evaluated the impact of incomplete revascularization on the occurrence of major cardiovascular events (MACE) at one-year follow-up. Methods: A total of 831 ACS patients undergoing PCI were divided into 3 subgroups according to their estimated Glomerular Filtration Rate (eGFR): 695 with eGFR >= 60 mL/min/1.73 m(2), 108 with eGFR 60-30 mL/min/1.73 m(2), 28 with eGFR < 30 mL/min/1.73 m(2). Initial SYNTAX score (SS) and rSS were calculated for all patients. Incomplete revascularization was defined by rSS > 8. The primary endpoint was the occurrence of MACE (all-cause mortality, myocardial infarction (MI), repeated revascularization except from planned revascularization, stroke and definite or probable recurrent stent thrombosis) one year after the index procedure. Results: Severe CKD patients had significantly higher MACE (12.0% vs. 25.9% vs. 35.7%; p < 0.001), all-cause mortality, cardiovascular mortality and heart failure events. Patients with rSS > 8 had higher MACE, all-cause and cardiovascular mortality. CKD was an independent predictive factor of rSS > 8 (HR: 1.65, 95% CI: 1.01 to 2.71; p = 0.048). Multivariate analysis identified rSS > 8, but not CKD, as an independent predictor of cardiac death and MACE. Conclusion: In ACS, CKD is predictive of incomplete revascularization, which stands out as a strong predictor of adverse cardiovascular outcomes including cardiac death and MACE.

引用

页数：15

共 27 条

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