Study Of The Relationship Between Renal Function And Acute Coronary Syndrome And Prognosis Of PCI

Objective:This study aims to investigate the renal function of patients with ACS,and thecorrelation between the eGFR、Microalbuminuria、uric acid(UA)、lipoprotein a[Lp(a)] andSeverrity of coronary lesions,and the relationship between eGFR and the prognosis of PCI.Methods:A total of 323 patients treated in our hospital who were diagnosed by coronaryangiography were studied.The patients were divided into 3 groups: eGFR≥90 ml/min/1.73m~2（group1，n=207），75ml/min/1.73m~2≤eGFR＜90ml/min/1.73m~2组（group2,n=72），eGFR<75ml/min/1.73m~2组（group3,n=44）.We recorded their general clinical information,suchas:age、sex、complications、drugs,etc.Serum creatinine、Microalbuminuria、uric acid、lipoproteina were measured.The methods of main index determination: Serum creatinine :picric acidmethod; urinary albumin: immune turbidity method ; uric acid:enzyme method; lipoproteina:immune turbidity method.Other parameters were independently measured in our ownbiochemistry laboratory.The patients of groupA、B、C were who received PCI in group1、2、3.We followed up the patients of groupA、B、C,recorded mortaity,major cardiovascular events(MACE),took time of aspirin and clopidogrel and rehospitalization for angina.All data wereanalyzed and compared by SPSS16.0.Results:(1)In our study ,there are 207(64.09%)patients eGFR≥90 ml/min/1.73m~2,103(31.89%) patients eGFR 60-90 ml/min/1.73m~2,13(4.02%) Patients eGFR<60ml/min/1.73m~2.(2)The general clinical information among group1、2、3 were comparable.(3)In group1、2、3 ,the values of eGFR were significant decrease [(113.39±16.39 )ml/min/1.73m~2vs(83.78±4.39) ml/min/1.73m~2vs (64.45±8.71) ml/min/1.73m~2,P＜0.01],the values of Serumcreatinine were increased gradually[(68.21±38.35 )umol/L vs (79.23±11.29 )umol/L vs(86.25±18.34) umol/L，group 1 vs group 2, P＜0.05，group1 vs group3, P＜0.01], the values ofMAlb[(11.23±5.50)mg/L vs( 14.50±6.48) mg/L vs (23.46±6.34 )mg/L]、uricacid[（285.30±67.17）umol/L vs (322.07±61.92) umol/L vs (392±36.95) umol/L]、lipoproteina[（16.68±16.47）mg/dL vs (25.66±21.45) mg/dL vs (54.82±19.35) mg/dL]were significantincreased,the didiffrernce were statistically significan ,all P＜0.01. The values of Gensini scorewere increased gradually（28.09±26.64 vs 36.5±0.66 vs 55.98±33.75，group1 vs group2, P＜0.05;group3 vs group1 and group2, P＜0.01).(4)In group 1、2、3,the single vessel disease weredecreased gradually (53.6% vs 40.3% vs 15.0%,group3 vs group1 and group2, P＜0.0167),thetwo vessel disease（22.7 vs 33.3 vs 38.6，group1vs group2, P＜0.0167）were increased gradually, the three vessel disease (15.5% vs 22.2% vs 38.6%，group1 vs group3, P＜0.0167) weresignificant increased ,sugested CABG(5.3% vs 8.3% vs 20.5%，group1vs group3, P＜0.0167)were significant increased. There were no statistically difference in the left main disease（3.4% vs 4.2% vs 6.8%）、PCI（47.8% vs 50% vs 52.3%）、average of stents number in PCI（1.17±0.43 vs 1.27±0.66 vs 1.30±0.56）and sugested drug therapy（46.9% vs 41.7% vs27.3%）,all P >0.05.(5)Correlation analysis:There was a significant negative correlation betweenGensini score and eGFR (r=-0.749，P＜0.001),there were significant positive correlationbetween Gensini score and Microalbuminuria (r=0.584，P＜0.001)、uric acid(r=0.616，P＜0.001)、lipoprotein a(r=0.597，P＜0.001) .(6) The general clinical information among groupA、B、C were comparable. (7)Results of follow up:there were no statistically difference in follow uptime(19.95±3.82vs19.88±4.22vs20.07±3.78),mortality(0% vs 2.8% vs 0%),MACE(1%vs2.8%vs4.3%), took time of aspirin (19.74±3.85vs19.88±4.22vs19.55±3.65) and clopidogrel(14.23±3.43vs 14.56±3.57 vs 14.68±4.08) ,rehospitalization for angina(9.1%vs5.6%vs21.7%)and out offollowed(17.2% vs 5.6% vs 21.7%).Conclusions:(1)The incidence rate of ACS combine CKD is high.Estimated GFR is betterthan Serum creatinine in judgement prophase renal hypofunction.It’s valuable in clinicalapplication.(2)Patients with ACS,the renal function lesion more obvious,the more serious andcomplexed in coronary artery disorder,the more difficult in treatment.(3) Microalbuminuria、uricacid、lipoprotein a are markers about renal function decreased,and positively relate to severity ofcoronary artery disease.Prompt that CKD cause atheroscleosis is relat to the elevated levels ofthe three.(4)Our study haven’t observed CKD affect the prognosis of PCI.