| 정해창, 안영근, 정명호, 정종원, 조정선, 심두선, 윤남식, 문재연, 김계훈, 박형욱, 홍영준, 김주한, 조정관, 박종춘 |
Background: Coronary artery disease is the principal cause of death in patients with chronic kidney disease (CKD). But, only few patients with advanced renal disease have been enrolled in trials comparing treatment modalities in ACS. The impact of GFR on coronary artery disease remained unclear. Methods: We studied the impact of renal function on development of MACE in 446 patients (70±8 years of age; 67 % male) admitted with ACS and treated with percutaneous coronary intervention (PCI) between Nov 2005 and Dec 2006. The patients were categorized into normal GFR (greater than 60 mL/min/1.73 m2, group I) and decreased GFR (less than 60 mL/min/1.73 m2, group II). Decreased GFR group was further categorized into moderate CKD (GFR of 30 to 59 mL/min/1.73 m2, group IIa) and severe CKD (GFR less than 30 mL/min/1.73 m2, group IIb). We compared the clinical characteristics, coronary angiographic findings, and long term outcomes between the groups. The primary end point is in-hospital mortality, morbidity, and MACE of 6-month clinical follow-up. Results: Group I was 228 patients (67±6 years, 66 % male, 51 % hypertension, 30 % diabetes, 63 % STEMI, 30 % NSTEMI, 7 % UAP) and group II was 218 patients (72±8 years, 65 % male, 51 % hypertension, 33 % diabetes, 69 % STEMI, 28 % NSTEMI, 3 % UAP. Involved vessel number was higher in group II (1.81 vs 2.21, p=0.005). Multi-vessel disease and complex lesion (Type B2, C) was more prevalent in group II (69 % vs 75 %, p=0.005). The rate of primary end point was higher in group II (24 % vs 36 %, p=0.013). In group II, primary end point was higher in group IIb rather than IIa (31 % vs 50 %, p=0.019). In multi-variate analysis, high level of hs-CRP (odds ratio 1.13, 95% CI 1.04 to 1.22, p=0.005) and low level of hematocrit (odds ratio 1.01, 95% CI 1.01 to 1.05, p = 0.006) were an independent predictors for MACE in in patients with ACS who have reduced renal function. Conclusions: Impaired renal function showed to worsen the long-term prognosis of ACS patients treated with PCI. And high hs-CRP and low hematocrit predicted MACE in patients with ACS who have decreased renal function.
|
