晚期慢性肾病(CKD)在冠心病(CAD)患者中很常见,血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)可以改善心脏和肾功能,但在这些高危患者中,ACEI/ARB治疗是否能改善长期预后尚不清楚.因此,本研究旨在探讨ACEI/ARB治疗与晚期CKDCAD患者长期预后的关系.
■5家医院纳入了晚期CKD的CAD患者。晚期CKD定义为每1.73m2估计的肾小球滤过率(eGFR)<30ml/min。Cox回归模型和竞争风险Fine和Gray模型用于检查ACEI/ARB治疗与全因死亡和心血管死亡之间的关系。分别。
■2527名患者,我们队列中有47.6%的人群因ACEI/ARB而出院。全因死亡率和心血管死亡率分别为38.6%和24.7%,分别。多因素Cox回归分析表明,ACEI/ARB治疗与全因死亡率(风险比(HR)=0.836,95%置信区间(CI):0.738-0.948,p=0.005)和心血管死亡率(HR=0.817,95CI:0.699-0.956,p=0.011)均较低相关。在倾向匹配队列中,生存获益是一致的,在接受ACEI/ARB治疗的患者中,全因死亡率(HR=0.856,95CI:0.752-0.974,p=0.019)和心血管死亡率(HR=0.830,95CI:0.707-0.974,p=0.023)的生存率显著提高.
在长期随访中,ACEI/ARB治疗在晚期CKD的高风险CAD患者中显示出更好的生存获益,这表明维持ACEI/ARB治疗的策略可能会改善这些高危人群的临床结局.
目前关于该主题的知识是什么?晚期CKD非常普遍,并且与CAD患者中更高的死亡风险和更差的预后密切相关。晚期CKD患者通常被排除在随机对照试验之外,为这些高风险CAD患者创造了证据空白。ACEI/ARB有利于提高CAD患者的生存率,但在晚期CKD的CAD患者中,ACEI/ARB治疗对长期预后的影响尚不清楚.这项研究为我们的知识增加了什么?在长期随访中,ACEI/ARB治疗在晚期CKD的高风险CAD患者中显示出更好的生存获益。这将如何改变临床药理学或转化科学?患有晚期CKD的CAD患者不仅预后较差,而且在选择治疗策略方面也受到限制。我们的研究可能为这些高危人群的长期预后的后续改善提供重要参考。
UNASSIGNED: Advanced chronic kidney disease (CKD) is common among patients with coronary artery disease (CAD), and angiotensin‑converting enzyme inhibitors (ACEI) or angiotensin‑receptor blockers (ARB) can improve cardiac and renal function, but whether ACEI/ARB therapy improves long-term prognosis remains unclear among these high-risk patients. Therefore, this research aimed to investigate the relationship between ACEI/ARB therapy and long-term prognosis among CAD patients with advanced CKD.
UNASSIGNED: CAD patients with advanced CKD were included in five hospitals. Advanced CKD was defined as estimated glomerular filtration rate (eGFR)<30 ml/min per 1.73 m2. Cox regression models and competing risk Fine and Gray models were used to examine the relationship between ACEI/ARB therapy and all-cause and cardiovascular death, respectively.
UNASSIGNED: Of 2527 patients, 47.6% population of our cohort was discharged on ACEI/ARB. The overall all-cause and cardiovascular mortality were 38.6% and 24.7%, respectively. Multivariate Cox regression analyses indicated that ACEI/ARB therapy was found to be associated with lower rates of both all-cause mortality (hazard ratio (HR)=0.836, 95% confidence interval (CI): 0.738-0.948, p = 0.005) and cardiovascular mortality (HR = 0.817, 95%CI: 0.699-0.956, p = 0.011). In the propensity-matched cohort, the survival benefit was consistent, and significantly better survival was observed for all-cause mortality (HR = 0.856, 95%CI: 0.752-0.974, p = 0.019) and cardiovascular mortality (HR = 0.830, 95%CI: 0.707-0.974, p = 0.023) among patients treated with ACEI/ARB.
UNASSIGNED: ACEI/ARB therapy showed a better survival benefit among high-risk CAD patients with advanced CKD at long-term follow-up, which manifested that strategies to maintain ACEI/ARB treatment may improve clinical outcomes among these high-risk populations.
What is the current knowledge on the topic? Advanced CKD is highly prevalent and strongly associated with higher mortality risk and worse outcomes among CAD patients, and patients with advanced CKD have often been excluded from randomized controlled trials, creating an evidence gap for these high-risk CAD patients. ACEI/ARB are beneficial for greater survival among CAD patients, but the effect of ACEI/ARB therapy on long-term prognosis is unclear among CAD patients with advanced CKD.What does this study add to our knowledge? ACEI/ARB treatment showed a better survival benefit among high-risk CAD patients with advanced CKD at long-term follow-up.How might this change clinical pharmacology or translational science? CAD patients with advanced CKD are not only have worse outcomes but also limited in their choice of therapy strategies. Our study may prompt an important reference for the subsequent improvement of long-term prognosis among these high-risk populations.