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目的 多中心、前瞻性评价急性ST段抬高型心肌梗死(STEMI)患者入院时肾功能不全对院内及6年长期预后的影响.方法 连续入718例发病后24 h内到北京市19家医院就诊的STEMI患者,根据入院时由简化MDRD公式计算的估算的GFR(eGFR)分为肾功能代偿组(eGFR≥60 ml·min-1·1.73 m-2)和肾功能不全组(eGFR＜ 60 ml·min-1·1.73 m-2),比较两组临床特点和院内预后及6年随访情况.结果718例患者中133例(18.5％)患者存在肾功能不全,与肾功能代偿组比较,肾功能不全组患者年龄较大,女性较多,既往有高血压、糖尿病、心力衰竭病史者较多,入院时KillipⅡ级以上比例较高,胸痛患者较少,接受急诊经皮冠状动脉介入治疗(PCI)比例较低.肾功能不全组的院内死亡(16.5％比2.6％,P＜0.001)、主要不良心血管事件(MACE)(60.9％比24.4％,P＜0.001)和6年全因死亡(35.3％比11.4％,P＜0.001)、心血管死亡(15.9％比5.7％,P=0.001)、MACE(52.4％比28.0％,P＜0.001)均显著高于肾功能代偿组.入院肾功能不全是STEMI患者院内MACE(OR2.120,95％ CI1.563 ～2.878,P=0.003)和6年全因死亡(RR2.122,95％ CI1.127 ～ 3.996,P=0.020)及MACE(OR1.586,95％ CI1.003 ～2.530,P=0.047)的独立预测因子.结论入院时伴肾功能不全的STEMI患者死亡和MACE明显升高,肾功能不全是STEMI患者院内及长期不良预后的独立预测因子.

Objective To investigate impact of admission renal dysfunction on in-hospital and longterm outcome of patients with ST-elevation myocardial infarction (STEMI).Methods This was a multicentre,observational,prospective-cohort study.Totally 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI.Estimation of glomerular filtration rate (eGFR) was calculated according to the abbreviated MDRD equation.The patients were categorized into two groups as renal preservation group(eGFR ≥60 ml · min-1 · 1.73 m-2) and renal dysfunction group(eGFR ＜ 60 ml ·min-1 · 1.73 m-2).The association between admission renal dysfunction and in-hospital and six-year outcome was evaluated.Results A total of 718 patients with STEMI were evaluated.There were 551 men and 167 women with age of (61.0 ± 13.0) years.One hundred and thirty-three patients(18.5％) had renal dysfunction.Patients with renal dysfunction were more often female and older,more patients had hypertension,diabetes and heart failure,and more patients had ≥ Killip Ⅱ classes on admission.These patients were less likely to present with chest pain.The in-hospital mortality(16.5％ vs 2.6％,P＜0.001),major adverse cardiac events(MACE) (60.9％ vs 24.4％,P ＜0.001),six-year all-cause mortality(35.3％vs 11.4％,P ＜ 0.001),six-year cardiac mortality (15.9％ vs 5.7％,P =0.001) and six-year MACE (52.4％ vs 28.0％,P ＜ 0.001)were markedly increased in renal dysfunction group than in renal preservation group.After adjusting for other confounding factors,renal dysfunction was an independent predictor of in-hospital MACE (OR 2.120,95％ CI 1.563-2.878,P =0.003),six-year all-cause mortality (RR 2.122,95％ CI 1.127-3.996,P =0.020) and six-year MACE(RR 1.586,95％ CI 1.003-2.530,P =0.047).Conclusions The mortality and MACE in STEMI patients with renal dysfunction were higher than in those with preserved renal function.Renal dysfunction evaluated by eGFR on admission is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.