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第68届美国心脏病学会科学年会（ACC 2019）于3月16日至18日在新奥尔良Ernest N. Morial会议中心举办。广东省人民医院陈纪言、谭宁教授团队的一项研究入选大会壁报，评估了接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死患者中，1型心肾综合征的发生率和预后。

研究简介

1型心肾综合征（CRS-1）定义为急性心脏病患者的急性肾损伤（AKI），最常见于急性失代偿性心力衰竭，与心衰患者的不良预后相关。在急性心肌梗死患者中，CRS-1的发生率和预后尚不清楚。

在这项前瞻性观察性研究中，研究者在2010年1月至2013年12月期间连续纳入了1309名接受PCI治疗的急性心肌梗死患者；在CRS-1组和非CRS-1组之间比较了基线特征和预后。采用Kaplan-Meier和多变量Cox回归分析来确定CRS-1与长期死亡率的关联。

在急性心梗患者中，CRS-1的总体发生率为8.9％。平均随访2.46±0.12年，Kaplan-Meier分析发现，CRS-1患者的全因死亡率显著升高（36.67％ vs 7.52％，P<0.0001）。多变量Cox回归分析显示，CRS-1与住院急性心梗患者PCI后长期死亡率增加显著相关（校正风险比=5.221, 95％CI：1.086-25.103; P<0.039）。

CRS-1经常发生，并且与住院急性心梗患者PCI后的长期不良预后显著相关。需要进一步的大样本研究来探索急性心梗患者中CRS-1的预防策略。

研究摘要

Title: Incidence and Prognosis of Type 1 Cardiorenal Syndromes Among Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention（1200-001 / 001）

Authors: Jin Liu, Guoli Sun, Yibo He, Feier Song, Zhaodong Guo, Shiqun Chen, Bowen Liu, Li Lei, Lihao He, Jiyan Chen, Yong Liu, Ning Tan, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease, Guangzhou, People's Republic of China

Background: Type 1 cardiorenal syndrome (CRS-1), defined as acute kidney injury (AKI) in patients with acute cardiac illness, most commonly acute decompensated heart failure (ADHF), was a universal complication with adverse outcomes among patients with heart failure (HF). However, the incidence and prognosis of CRS-1 was unknown among patients with acute myocardial infarction (AMI).

Methods: We recruited 1309 consecutive AMI patients underwent PCI between January 2010 and December 2013 in this prospective, observational study. The baseline characteristics and outcomes were compared between subjects with or without CRS-1. Kaplan-Meier and multivariate Cox regression analyses were used to determine associations of development of CRS-1 with long-term mortality.

Results: Overall incidence of CRS-1 in AMI patients was 8.9%. The mean follow-up period was 2.46 ± 0.12 years, and Kaplan-Meier analysis found that CRS-1 patients had a higher all-cause mortality (36.67% vs 7.52%, P <0.0001) among AMI patients. Multivariate Cox regression analysis showed that CRS-1 was significantly associated with increased long-term mortality (adjusted hazard ratio = 5.221, 95% CI: 1.086-25.103; P <0.039) following PCI among hospitalised AMI patients.

Conclusion: CRS-1 occurs frequently and is significantly associated with long-term worse outcomes following PCI among hospitalised AMI patients. Further large-sample studies are needed to explore preventive strategies for CRS-1 among AMI patients.

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