[Analysis of prognostic factors in patients with acute coronary syndrome complicated with moderate to severe chronic kidney disease after percutaneous coronary intervention].

Abstract

Objective: To explore the prognostic factors of patients with acute coronary syndrome (ACS) complicated with moderate to severe chronic kidney disease (CKD) after percutaneous coronary intervention (PCI) and to establish a risk predictive model.

Methods: The medical records of 148 ACS patients with moderate to severe CKD who received PCI in the Department of Cardiology, Peking University Third Hospital from September 2021 to January 2023 and completed 12-month follow-up were retrospectively analyzed. According to whether the patients had a major adverse cardiovascular disease (MACE) 12 months after PCI, they were divided into MACE group and non-MACE group. Binary Logistic regression analysis was performed on the general clinical data, clinical test results, echocardiography, coronary angiography and PCI data of the two groups of patients, the prognostic factors were analyzed by backward stepwise regression, and the risk prediction model was established. The receiver operating characteristic (ROC) curve was drawn to test the predictive efficiency of the model.

Results: A total of 148 patients with ACS combined with moderate to severe CKD were included in the study, including 50 patients in the MACE group and 98 patients in the non-MACE group, and the incidence of MACE 12 months after PCI was 33.8%.Binary Logistic analysis of hospitalization data of the two groups showed that white blood cell (OR＝1.145; 95%CI: 1.017-1.290; P＝0.026), age (OR＝1.032; 95%CI: 1.001-1.065; P＝0.046) and left ventricular ejection fraction (LVEF; OR＝0.962; 95%CI: 0.934-0.990; P＝0.009) were independent influencing factors for MACE 12 months after PCI (P < 0.05), CKD stage was not associated with the occurrence of MACE 12 months after PCI. The risk prediction model for MACE was Logit(P) = 0.032× age +0.136× leukocyte－0.039×LVEF. ROC curve analysis showed that this model had good prediction efficiency, and the area under the curve (AUC) predicted by the prediction model was 0.749, 95%CI was 0.666 to 0.832. The sensitivity and specificity were 72% and 68%.

Conclusion: The incidence of MACE was higher in ACS patients with moderate to severe CKD 12 months after PCI, and white blood cells, age and LVEF were independent factors influencing the occurrence of MACE in these patients after PCI.