易东,孟晨伟,简讯,刘道权,徐林,罗婷,鄢华

• 1:武汉亚洲心脏病医院心内科

摘要(Abstract)：

目的 分析慢性肾病（CKD）对血管内超声（IVUS）指导下经皮冠状动脉介入治疗（PCI）的左主干冠状动脉疾病（LMCAD）患者预后的影响。方法 回顾性纳入2017年1月至2020年12月武汉亚洲心脏病医院心内科收治的LMCAD行IVUS指导的PCI患者。根据是否合并CKD分为CKD组和非CKD组。通过电子病历系统收集患者的临床资料，对比患者在临床特征和预后方面的差异，随访终点为主要不良心血管事件（MACE，定义为全因死亡、心肌梗死、脑卒中的复合终点）。结果 共纳入LMCAD患者325例，平均年龄（62.56±9.86）岁，男性73.54%。所有患者CKD组31例（9.54%），中位随访5年。合并CKD患者年龄更大[（70.13±9.77）岁比（61.77±9.54）岁，P<0.001]，合并三支病变（64.52%比38.10%,P=0.040）和前三叉真性分叉病变（45.16%比37.76%,P=0.011）比例更高，IVUS下钙化度数更高（P=0.029），中位SYNTAXⅡ评分更高[（34.10(30.30,39.25)分比26.75(22.42,31.58)分，P<0.001）]。CKD组患者MACE发生率（32.26%比9.18%,P<0.001）高于非CKD组患者，单因素Cox回归及Kaplan-Meier曲线证实CKD组患者MACE发生率高于非CKD组（HR 5.877,95%CI 2.765～12.494），校正年龄和心功能后，CKD仍然是MACE的独立危险因素（HR 3.611,95%CI 1.634～7.978）。结论 合并CKD的LMCAD患者年龄更大，心功能更差，病变累及范围更广泛，钙化程度更严重，CKD患者远期预后更差。

关键词(KeyWords)： 左主干冠状动脉疾病;慢性肾病;冠状动脉介入治疗;血管内超声;预后

Abstract:

Keywords:

基金项目(Foundation): 武汉市知识创新专项项目（2022020801010576）;; 武汉市医学科学研究项目（WX23J02）;; 武汉市心血管影像临床医学研究中心开放基金项目（CMRC202303）;; 生物靶向治疗研究湖北省重点实验室开放基金项目（2023swbx 007）

作者(Author): 易东,孟晨伟,简讯,刘道权,徐林,罗婷,鄢华

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