{"title":"终末期肾脏疾病对急性心肌梗死后患者死亡率的影响:一项全国性研究","authors":"Cheng-Hung Chiang, Wan-Ting Hung, Ta-Hsin Tai, Chin-Chang Cheng, Kun-Chang Lin, Shu-Hung Kuo, Su-Chiang Lin, Pei-Ling Tang, Chong-En Gao, Pei-Yu Weng, Yu-Ling Ko, Yun-Ju Fu, Feng-Yu Kuo, Wei-Chun Huang","doi":"10.1097/JCMA.0000000000000953","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD.</p><p><strong>Results: </strong>A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups.</p><p><strong>Conclusion: </strong>ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":"86 8","pages":"740-747"},"PeriodicalIF":1.9000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of end-stage kidney disease on mortality in patients after acute myocardial infarction: A nationwide study.\",\"authors\":\"Cheng-Hung Chiang, Wan-Ting Hung, Ta-Hsin Tai, Chin-Chang Cheng, Kun-Chang Lin, Shu-Hung Kuo, Su-Chiang Lin, Pei-Ling Tang, Chong-En Gao, Pei-Yu Weng, Yu-Ling Ko, Yun-Ju Fu, Feng-Yu Kuo, Wei-Chun Huang\",\"doi\":\"10.1097/JCMA.0000000000000953\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD.</p><p><strong>Results: </strong>A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups.</p><p><strong>Conclusion: </strong>ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.</p>\",\"PeriodicalId\":17251,\"journal\":{\"name\":\"Journal of the Chinese Medical Association\",\"volume\":\"86 8\",\"pages\":\"740-747\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2023-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Chinese Medical Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JCMA.0000000000000953\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Chinese Medical Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JCMA.0000000000000953","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:本研究旨在评估终末期肾脏疾病(ESKD)对首次急性心肌梗死(AMI)患者死亡率的影响。方法:这是一项回顾性的全国性队列研究。纳入了2000年1月1日至2012年12月31日期间诊断为首次AMI的患者。所有患者随访至死亡或2012年12月31日，以先发生者为准。采用一对一倾向评分匹配技术将ESKD患者与性别、年龄、合并症和冠状动脉介入治疗(包括经皮冠状动脉介入治疗[PCI]和冠状动脉旁路移植术[CABG])相似的无ESKD患者进行匹配。构建Kaplan-Meier累积生存曲线来比较合并和不合并ESKD的AMI患者。结果:共纳入186112例患者，鉴定出8056例ESKD患者。倾向评分匹配的8056例无ESKD患者被纳入比较。总体而言，包括性别、年龄、PCI和CABG亚组在内，ESKD患者的12年死亡率显著高于无ESKD患者(log-rank p < 0.0001)。在Cox比例风险回归分析中，ESKD是首次AMI患者死亡的独立危险因素(风险比，1.77;95% ci, 1.70-1.84;P < 0.0001)。亚组分析的森林图显示，在AMI患者中，ESKD对男性死亡率有更高的影响;年轻的年龄;无高血压、糖尿病、外周血管疾病、心力衰竭、脑血管意外、慢性阻塞性肺疾病等合并症;接受PCI和CABG亚组。结论:ESKD显著增加首次AMI患者的死亡风险，不分性别、不同年龄、是否行PCI或CABG。在AMI患者中，ESKD对男性、年轻、无合并症、接受PCI和CABG的患者的死亡率有很高的影响。
The impact of end-stage kidney disease on mortality in patients after acute myocardial infarction: A nationwide study.
Background: This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI).
Methods: This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD.
Results: A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups.
Conclusion: ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.
期刊介绍：
Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health.
JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor
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