| BackgroundWhen the emergency percutaneous coronary intervention(PCI) therapy is widely spread, the incidence of death or MACE has a significant decrease of the number of the patients with acute myocardial infarction(AMI) during the hospitalization, but AMI is still the important cause of death in most countries. Renal dysfunction is a common complication in patients with acute myocardial infarction and short(long) period of prognosis of the independent risk factors.PurposePatients with acute myocardial infarction in accordance with the level of e GFR can be divided into normal renal function group,the mild abnormal renal function normal group,the moderately or severe abnormal renal function in all three groups, while emergency percutaneous coronary intervention was done at the same time, through the comparison between the three groups of hospital clinical characteristics, death and major adverse cardiac events(MACE) during hospital, study PCI postoperative patients with acute myocardial infarction patients with abnormal renal function of the clinical characteristics and prognosis in the near future.MethodsElected 542 patients from January 1st,2013 to April 30th,2015 who accepted emergency coronary intervention treatment with acute myocardial infarction(AMI)in the First Affiliated Hospital of Soochow University.According to the modified Modification of Diet in takes diseases(MDRD)equation(GFR(ml/min/1.73m2)=186×Scr-1.154×年龄-0.203×(0.742 if it is women),according to the serum creatinine values calculated on admission to hospital estimated glomerular filtration rate(e GFR),according to the e GFR divided the patients into normal Renal function(namely the control group,group A,e GFR>90 ml/min/1.73 m2),mild kidney dysfunction group(group B,60<e GFR≤90ml/min/1.73m2),moderately severe abnormal Renal function group(group C,e GFR≤60ml/min/1.73 m2 or less),group B and group C are collectively referred to as abnormal Renal function group.Comparing three groups on the Clinical characteristics and short-term prognosis of differences.The end:the primary end point for hospitalization,for all-cause mortality was defined as any cause of death in hospital.Secondary end points for major adverse cardiovascular events(MACE)during hospitalization,defined as the onset of paroxysmal atrial fibrillation and heart failure,malignant arrhythmia seizures.General data,complications in patients with collection,laboratory testing data on admission,coronary angiography and reperfusion therapy.Whether the incident record primary and secondary end points.Observe group A,group B and group C the clinical characteristics,death and the incidence of MACE.Results1.Clinical data:This study selected 542 patients with emergency PCI, A group of 249 cases, accounting for 45.9%, B group of 194 cases, accounting for 35.8%, group C for 99 cases, accounting for 18.3%. Three groups of patients with smoking history, history of dyslipidemia on admission, history of angina pectoris show no statistical difference(P >0.05); the three groups of gender, history of hypertension, diabetes, history, history of stroke, show statistically significant(P < 0.05), compared with the control group(group A),mild kidney dysfunction group has the higher percentage on history of high blood pressure,which was statistically difference(P < 0.05), sex ratio, history of diabetes and stroke show no significant statistical difference(P > 0.05); Compared with the control group(group A),the moderately or severe abnormal renal function group in history of hypertension,diabetes, stroke history ratio is higher,which is statistically significant(P < 0.05).2. Myocardial infarction incidence:Compared with the control group(group A), mild kidney dysfunction group(group B)on uric acid, age, NT- pro- BNP, urea level is higher,and the low level of hemoglobin, which are statistically significant(P < 0.05); In the hospitalization days, heart rate, blood pressure, CK- MB, blood lipid, blood glucose,hs-CRP, left ventricular contraction, left ventricular end-diastolic diameter and left ventricular ejection fraction(LVEF), it shows no significant statistical differences between the two groups(P > 0.05); Compared with the control group, the moderately or severe abnormal renal function group(group C) on uric acid, age, NT- pro- BNP, urea, heart rate,blood glucose level is higher, and hemoglobin levels, diastolic blood pressure, blood fatLVEF are lower, which are statistically significant(P < 0.05), and hospitalization days,systolic blood pressure, CK- MB, end of the left ventricular contraction, left ventricular end-diastolic diameter,it shows no significant statistical differences between the two groups(P > 0.05)3.Coronary angiogram station:Infarction related vascular is no significant statistical differences between the three groups(P > 0.05), compared with control group, the mild kidney dysfunction group more lesion blood vessel count and higher Killip classification,statistically significant(P < 0.05); Compared with control group, the moderately or severe abnormal renal function lesion blood vessel counts more and high Killip classification,statistically significant(P < 0.05).4.Hospital death and MACE: three groups of in-hospital death and MACE have significantly statistical differences(P < 0.05), compared with control group, the mild kidney dysfunction group hospitalization greater incidence of MACE, at 18.6%, compared to control group 11.6%, the incidence of MACE had significant statistical difference(P <0.05). Compared with the control group, moderately or severe abnormal renal function group in-hospital mortality(16.2%), MACE, a high incidence(30.3%), mortality is much higher than the control group(3.2%), MACE(11.6%), the incidence of difference has significant statistical difference(P < 0.05). Compared with mild abnormal renal function group, the moderately or severe abnormal renal function group in-hospital mortality(16.2%), MACE, a high incidence(30.3%), far higher than the control group(4.1%),MACE mortality(18.6%), the incidence of difference has significant statistical difference(P < 0.05).5.Logistic regression analysis :Through multivariate Logistic regression analysis, the adjusted for gender, age, hypertension, diabetes, stroke, lesion blood vessel number, Killip classification, uric acid, the factors such as hemoglobin, blood pressure, blood fat, LVEF,pro- BNP levels, e GFR≤60 ml/min / 1.73 m2 or less is postoperative hospital stay independent risk factors for death and MACE with acute myocardial infarction after the treatment of emergency PCI.Conclusion1.Compared with control group, mildly abnormal renal function group has the more incidence of hospital MACE; Compared with control group, the moderately or severe abnormal renal function group has the more hospital mortality and incidence of MACE;Compared with mild abnormal renal function,the moderately or severe abnormal renal function group has more hospital mortality and incidence of MACE.2. The moderately or severe abnormal renal function and the rise of NT- pro- BNP levels are the independent risk factors of short-term prognosis with AMI patients after the treatment of PCI. |
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