Background: Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).
Methods: Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.
Results: A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min-1·1.73 m-2), 26.0% (118/454) in Group 2 (120 ml·min-1·1.73 m-2> eGFR ≥90 ml·min-1·1.73m-2), 18.3% (86/469) in Group 3 (90 ml·min-1·1.73 m-2> eGFR ≥60 ml·min-1·1.73 m-2), 21.8% (26/119) in Group 4 (60 ml·min-1·1.73 m-2> eGFR ≥30 ml·min-1·1.73 m-2), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min-1·1.73 m-2), with statistical significance (χ2 = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min-1·1.73 m-2). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ2 = 16.26, P = 0.009 at 6-month follow-up, and χ2 = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.
Conclusions: High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.
行急诊经皮冠状动脉介入治疗的患者高水平估算的肾小球滤过率与对比剂诱导的急性肾损伤的关系摘要背景：大量研究显示，在冠心病患者中低水平的估算肾小球滤过率(eGFR，estimated glomerular filtration rate)与不良临床结局相关。然而，关于高水平的eGFR却鲜有报道。本研究目的是在行急诊经皮冠状动脉介入治疗(PCI，percutaneous coronary intervention)的中国人群中探索基线eGFR水平-尤其是高水平eGFR-与对比剂诱导的急性肾损伤(CI-AKI，contrast-induced acute kidney injury)之间的关系。 方法：将2013-2015年间于我院行急诊PCI的患者纳入研究，并根据术前eGFR水平将患者分为5组。收集并分析患者基线资料，对比各组CI-AKI的发生率和术后6月、12月复合终点事件(包括非致死性心肌梗死、再次血运重建、卒中和全因死亡)发生率的差异，并对CI-AKI的危险因素进行Logistic分析。 结果：本研究共纳入1061例患者，总CI-AKI发生率为22.7%(241/1061)。随eGFR水平的降低，各组CI-AKI发生率分别为77.8%(7/9)(组1：eGFR ≥ 120 ml·min-1·1.73m-2)，26.0%(118/454)(组2：120 ml·min-1·1.73m-2 > eGFR ≥ 90 ml·min-1·1.73m-2)，18.3%(86/469)(组3：90 ml·min-1·1.73m-2 > eGFR ≥ 60 ml·min-1·1.73m-2)，21.8%(26/119)(组4：60 ml·min-1·1.73m-2 > eGFR ≥ 30 ml·min-1·1.73m-2)，和40.0%(4/10)(组5：eGFR < 30 ml·min-1·1.73m-2)，具有显著的统计学差异(χ2=25.19，P<0.001)。同时可见，随eGFR下降CI-AKI发生率呈U型，即在一定范围内(eGFR ≥ 60 ml·min-1·1.73m-2)，eGFR水平越高，CI-AKI发生率越高。术后6月5组患者复合终点事件发生率分别为0，0.9%，2.1%，6.7%，和 0，术后12月分别为0，3.3%，3.4%，16.0%，和30.0%，均具有统计学差异(术后6月χ2=16.26，P=0.009，术后12月χ2=49.05，P<0.001)。Logistic分析证实，在行急诊PCI的患者中eGFR是CI-AKI的独立危险因素。 结论：在行急诊PCI 的患者中，高水平的eGFR可能增加术后CI-AKI的发生风险。.
Keywords: Contrast-Induced Acute Kidney Injury; Emergency Percutaneous Coronary Intervention; Estimated Glomerular Filtration Rate.