Abstract: Objective To investigate the impact of glomerular filtration rate (GFR) on prognosis in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods A total of 118 AMI patients who were admitted to the Department of Cardiology of Liuzhou People's Hospital from June 2011 to July 2013 and met the inclusion criteria were enrolled in the study. According to the chronic kidney disease staging criteria issued by the National Kidney Foundation, the patients were divided into the normal estimated glomerular filtration rate (eGFR) group 〔eGFR≥90.0 ml·min⁻¹·(1.73 m²)⁻¹, n=56〕 and the low eGFR group 〔eGFR＜90.0 ml·min⁻¹·(1.73 m²)⁻¹, n=62〕. General clinical data including gender, age, smoking history, body mass index, prevalence of hypertension, diabetes mellitus, dyslipidemia, serum creatinine level, Killip classification, serum cardiac troponin Ⅰ level, eGFR on admission, and left ventricular ejection fraction within 3 days after admission were recorded. Results of coronary angiography including infarct-related artery (IRA) and coronary artery lesion characteristics (number of diseased coronary arteries, presence of left main coronary artery disease) were recorded. All patients were followed up regularly after PCI, and the incidence of major adverse cardiovascular events (MACE), including target vessel revascularization, non-fatal myocardial infarction and cardiac death, was documented. Results There were no significant differences in gender, smoking rate, body mass index, prevalence of hypertension, diabetes mellitus, dyslipidemia, Killip classification, serum cardiac troponin Ⅰ level and left ventricular ejection fraction between the two groups (P＞0.05). The age and serum creatinine level in the normal eGFR group were lower than those in the low eGFR group (P＜0.05). No significant differences were found in IRA, number of diseased coronary arteries and prevalence of left main coronary artery disease between the two groups (P＞0.05). There were no significant differences in the incidence of target vessel revascularization, non-fatal myocardial infarction and cardiac death between the two groups (P＞0.05), while the total incidence of MACE in the low eGFR group was significantly higher than that in the normal eGFR group (P＜0.05). The MACE-free survival rate in the low eGFR group was lower than that in the normal eGFR group (P＜0.05). Cox proportional hazard regression model analysis showed that after adjusting for other confounding factors, age 〔RR=1.564, 95%CI (1.059,2.413)〕, diabetes mellitus 〔RR=3.916, 95%CI (1.874,7.215)〕 and decreased eGFR 〔RR=3.323, 95%CI (1.452,6.820)〕 were independent influencing factors for MACE (P＜0.05). Conclusion Decreased eGFR in AMI patients with normal serum creatinine level is associated with adverse prognosis after primary PCI, and it is an independent predictor of MACE.

Key words: Myocardial infarction, Glomerular filtration rate, Prognosis, Angioplasty, balloon, coronary

摘要： 目的 研究肾小球滤过率对急性心肌梗死患者直接经皮冠状动脉介入术（PCI）后预后的影响。方法 选取 2011 年 6 月 —2013 年 7 月柳州市人民医院心血管内科符合纳入标准的急性心肌梗死患者 118 例为研究对象。根据美国肾脏基金会制定的慢性肾脏病分期标准，将患者分为正常估算肾小球滤过率（eGFR）组〔eGFR≥90.0 ml・min⁻¹・(1.73 m²)⁻¹，56 例〕和低 eGFR 组〔eGFR＜90.0 ml・min⁻¹・(1.73 m²)⁻¹，62 例〕。记录患者一般资料，包括性别、年龄、吸烟史、体质指数、高血压发生情况、糖尿病发生情况、血脂异常发生情况，入院血肌酐、心功能 Killip 分级、血清肌钙蛋白 Ⅰ、eGFR 以及入院 3 d 内左心室射血分数。记录冠状动脉造影结果〔梗死相关动脉（IRA）及冠状动脉病变情况（冠状动脉病变支数、是否合并左冠状动脉主干病变）〕。术后对所有患者进行随访，记录主要不良心血管事件（MACE）（包括靶血管血运重建、非致死性心肌梗死、心源性死亡）发生情况。结果 两组性别、吸烟率、体质指数、高血压发生率、糖尿病发生率、血脂异常发生率、入院心功能 Killip 分级、入院血清肌钙蛋白 Ⅰ、入院 3 d 内左心室射血分数比较，差异无统计学意义（P＞0.05）；正常 eGFR 组年龄小于低 eGFR 组，入院血肌酐低于低 eGFR 组（P＜0.05）。两组梗死相关动脉（IRA）、冠状动脉病变支数、合并左冠状动脉主干病变发生率比较，差异无统计学意义（P＞0.05）。两组靶血管血运重建、非致死性心肌梗死、心源性死亡发生率比较，差异无统计学意义（P＞0.05）；低 eGFR 组总 MACE 发生率高于正常 eGFR 组（P＜0.05）。低 eGFR 组无 MACE 生存率低于正常 eGFR 组（P＜0.05）。Cox 比例风险回归模型分析结果显示，在校正其他因素影响后，年龄〔RR=1.564，95% CI（1.059，2.413）〕、糖尿病〔RR=3.916，95% CI（1.874，7.215）〕、eGFR 下降〔RR=3.323，95% CI（1.452，6.820）〕是 MACE 的影响因素（P＜0.05）。结论 血肌酐处于参考范围时，eGFR 下降与急性心肌梗死患者直接 PCI 后不良预后有关，是发生 MACE 的独立预测因素。

关键词: 心肌梗死, 肾小球滤过率, 预后, 血管成形术, 气囊, 冠状动脉