PDF(Pubmed)
Abstract：
BACKGROUND: Advanced chronic kidney disease (ACKD) is common in patients undergoing percutaneous coronary intervention (PCI). Post-PCI bleeding has been shown to increase mortality and remains an important challenge in these patients. Previous studies have shown increased post-PCI bleeding in CKD patients but often ACKD patients are excluded from these trials. The goal of this study was to evaluate if patients undergoing PCI with advanced renal disease have higher bleeding complications.
METHODS: We analyzed the National Inpatient Sample (NIS) database to compare the post-PCI bleeding rates for ACKD (CKD stage 3 and above) undergoing PCI between 2006 and 2011 to those without ACKD in patients over the age of 40. Specific ICD-9 CM codes were used to identify these patients.
RESULTS: A total of 49,192 patients had post-PCI bleeding during the study period of which 3,675 (7.5%) had ACKD. Patients with ACKD were older (68.7±11.7 years). During the study period, there was a decline in post-PCI bleeding rates in both ACKD and control groups. Patients with ACKD have significantly higher post-PCI bleeding rates compared to the control group. For example, in 2006, 133.9 in patients with ACKD had bleeding vs. 104.4 per 100,000 in patients without ACKD (P<0.05). After multivariate adjustment for bassline comorbidities, ACKD remained independently associated with post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001).
CONCLUSIONS: Despite the overall decline in post-PCI bleeding in patients undergoing PCI, ACKD remains independently associated with post-procedural bleeding.
METHODS: We analyzed the National Inpatient Sample (NIS) database to compare the post-PCI bleeding rates for ACKD (CKD stage 3 and above) undergoing PCI between 2006 and 2011 to those without ACKD in patients over the age of 40. Specific ICD-9 CM codes were used to identify these patients.
RESULTS: A total of 49,192 patients had post-PCI bleeding during the study period of which 3,675 (7.5%) had ACKD. Patients with ACKD were older (68.7±11.7 years). During the study period, there was a decline in post-PCI bleeding rates in both ACKD and control groups. Patients with ACKD have significantly higher post-PCI bleeding rates compared to the control group. For example, in 2006, 133.9 in patients with ACKD had bleeding vs. 104.4 per 100,000 in patients without ACKD (P<0.05). After multivariate adjustment for bassline comorbidities, ACKD remained independently associated with post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001).
CONCLUSIONS: Despite the overall decline in post-PCI bleeding in patients undergoing PCI, ACKD remains independently associated with post-procedural bleeding.
摘要：
背景：晚期慢性肾脏病（ACKD）在经皮冠状动脉介入治疗（PCI）的患者中很常见。PCI术后出血已被证明会增加死亡率，并且在这些患者中仍然是一个重要的挑战。先前的研究表明CKD患者PCI后出血增加，但通常ACKD患者被排除在这些试验之外。这项研究的目的是评估接受PCI治疗的晚期肾病患者是否有更高的出血并发症。
方法：我们分析了国家住院患者样本（NIS）数据库，以比较2006年至2011年间接受PCI的ACKD（CKD3期及以上）与未接受ACKD的患者的PCI后出血率。使用特定的ICD-9CM代码来识别这些患者。
结果：在研究期间，共有49,192例患者出现PCI术后出血，其中3,675例（7.5%）出现ACKD。ACKD患者年龄较大（68.7±11.7岁）。在学习期间,ACKD组和对照组的PCI术后出血率都有所下降.ACKD患者PCI术后出血率明显高于对照组。例如,2006年，ACKD患者中有133.9例出血与没有ACKD的患者为104.4/100,000（P<0.05）。在对巴斯线合并症进行多变量调整后，ACKD与PCI术后出血风险独立相关(OR:1.07,CI:1.03-1.11,P<0.001)。
结论：尽管PCI术后出血总体下降，但ACKD仍与术后出血独立相关。
方法：我们分析了国家住院患者样本（NIS）数据库，以比较2006年至2011年间接受PCI的ACKD（CKD3期及以上）与未接受ACKD的患者的PCI后出血率。使用特定的ICD-9CM代码来识别这些患者。
结果：在研究期间，共有49,192例患者出现PCI术后出血，其中3,675例（7.5%）出现ACKD。ACKD患者年龄较大（68.7±11.7岁）。在学习期间,ACKD组和对照组的PCI术后出血率都有所下降.ACKD患者PCI术后出血率明显高于对照组。例如,2006年，ACKD患者中有133.9例出血与没有ACKD的患者为104.4/100,000（P<0.05）。在对巴斯线合并症进行多变量调整后，ACKD与PCI术后出血风险独立相关(OR:1.07,CI:1.03-1.11,P<0.001)。
结论：尽管PCI术后出血总体下降，但ACKD仍与术后出血独立相关。
