[1]赵梦琪 张杨 张松利 彭建军.晚期慢性肾脏病患者冠状动脉粥样硬化性心脏病治疗方案研究进展[J].心血管病学进展,2023,(7):581.[doi:10.16806/j.cnki.issn.1004-3934.2023.07.002]
　ZHAO Mengqi,ZHANG Yang,ZHANG Songli,et al.Current Status of Research on Treatment of Coronary Atherosclerotic Heart Disease in Patients with Advanced Chronic Kidney Disease[J].Advances in Cardiovascular Diseases,2023,(7):581.[doi:10.16806/j.cnki.issn.1004-3934.2023.07.002]
点击复制

晚期慢性肾脏病患者冠状动脉粥样硬化性心脏病治疗方案研究进展()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2023年7期
页码:
581
栏目:
综述
出版日期:
2023-07-25

文章信息/Info

Title:
Current Status of Research on Treatment of Coronary Atherosclerotic Heart Disease in Patients with Advanced Chronic Kidney Disease
作者:
赵梦琪 张杨 张松利 彭建军
(首都医科大学附属北京世纪坛医院心内科,北京100038)
Author(s):
ZHAO Mengqi;  ZHANG Yang;  ZHANG Songli;  PENG Jianjun
(Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China)
关键词:
晚期慢性肾脏病; 冠状动脉粥样硬化性心脏病; 治疗
Keywords:
Advanced chronic kidney disease; Coronary atherosclerotic heart disease; Treatment
DOI:
10.16806/j.cnki.issn.1004-3934.2023.07.002
摘要:
冠状动脉粥样硬化性心脏病（冠心病）是慢性肾脏病患者死亡的重要原因之一，尤其是晚期肾脏病[估算的肾小球滤过率＜30 mL/(min·1.73 m2)]。合并肾功能不全的冠心病患者心血管风险较高，预后较差。因警惕对比剂肾病风险，此类患者很少行冠状动脉造影检查来评估病变，且关于冠心病治疗的临床研究通常将晚期慢性肾脏病患者排除在外，导致此类患者最佳治疗方案尚无定论。现回顾冠心病合并晚期慢性肾脏病患者相关临床研究，总结目前对于该类患者最佳的治疗方法。在冠心病合并晚期慢性肾脏病患者中，对于ST段抬高型心肌梗死患者行血运重建治疗优于内科保守治疗。而非ST段抬高型心肌梗死及不稳定型心绞痛患者的最佳治疗方案尚无统一定论，仍需更多的临床研究证实。对于稳定型冠心病患者首选内科保守治疗。临床中仍需权衡利弊，对不同患者的治疗方法进行个体化指导。
Abstract:
Coronary atherosclerotic heart disease(CHD) is one of the important causes of death in patients with chronic kidney disease,especially in patients with advanced kidney disease [estimated glomerular filtration rate＜30 mL/(min·1.73 m 2)]. CHD patients with renal insufficiency have higher cardiovascular risk and poor prognosis. Because they are alert to the risk of contrast nephropathy,such patients seldom undergo coronary angiography to evaluate the pathological changes. Clinical studies on the treatment of CHD usually exclude patients with advanced chronic kidney disease,leading to the uncertainty of the best treatment scheme for such patients. This paper reviews the relevant clinical studies of patients with CHD complicated with advanced chronic kidney disease,and summarizes the best treatment methods for these patients at present. In patients with CHD complicated with advanced chronic kidney disease,revascularization therapy is superior to medical conservative treatment for patients with ST segment elevation myocardial infarction. However,the best treatment for patients with non-ST segment elevation myocardial infarction and unstable angina pectoris has not been determined,and more clinical studies are needed to confirm it. Conservative medical treatment is the first choice for patients with stable angina pectoris. In clinic,it is still necessary to weigh the pros and cons and give individualized guidance to the treatment methods of different patients.

参考文献/References:

[1] Tsao CW,Aday AW,Almarzooq ZI,et al. Heart disease and stroke statistics-2023 update:a report from the American Heart Association[J]. Circulation,2023,147(8):e93-e621.

[2] Lv JC,Zhang LX. Prevalence and disease burden of chronic kidney disease[J]. Adv Exp Med Biol,2019,1165:3-15.

[3] Saritas T,Floege J. Cardiovascular disease in patients with chronic kidney disease[J]. Herz,2020,45(2):122-128.

[4] Rodin R,Chan CT. Determinants and prevention of coronary disease in patients with chronic kidney disease[J]. Can J Cardiol,2019,35(9):1181-1187.

[5] Burlacu A,Genovesi S,Basile C,et al. Coronary artery disease in dialysis patients:evidence synthesis,controversies and proposed management strategies[J]. J Nephrol,2021,34(1):39-51.

[6] Sarnak MJ,Amann K,Bangalore S,et al. Chronic kidney disease and coronary?artery disease:JACC state-of-the-art review[J]. J Am Coll Cardiol,2019,74(14):1823-1838.

[7] Huang HD,Alam M,Hamzeh I,et al. Patients with severe chronic kidney disease benefit from early revascularization after acute coronary syndrome[J]. Int J Cardiol,2013,168(4):3741-3746.

[8] Costanzo P,D?avík V. Coronary revascularization in patients with advanced chronic kidney disease[J]. Can J Cardiol,2019,35(8):1002-1014.

[9] Davenport MS,Perazella MA,Yee J,et al. Use of intravenous iodinated contrast media in patients with kidney disease:consensus statements from the American College of Radiology and the National Kidney Foundation[J]. Radiology,2020,294(3):660-668.

[10] Allen LA,Pyart RD,Holmes J,et al. Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease:a case-control study[J]. QJM,2019,112(9):669-674.

[11] Chertow GM,Normand SL,McNeil BJ. “Renalism”:inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency[J]. J Am Soc Nephrol,2004,15(9):2462-2468.

[12] Moroni F,Spangaro A,Carlino M,et al. Impact of renal function on the immediate and long-term outcomes of percutaneous recanalization of coronary chronic total occlusions:a systematic review and meta-analysis[J]. Int J Cardiol,2020,317:200-206.

[13] Zhou YL,Chen LQ,Du XG. Efficacy of short-term moderate or high-dose statin therapy for the prevention of contrast-induced nephropathy in high-risk patients with chronic kidney disease:systematic review and meta-analysis[J]. Clinics(Sao Paulo),2021,76:e1876.

[14] Bhatt DL,Lopes RD,Harrington RA. Diagnosis and treatment of acute coronary syndromes:a review[J]. JAMA,2022,327(7):662-675.

[15] Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177.

[16] Khan MZ,Syed M,Osman M,et al. Contemporary trends and outcomes in patients with ST-segment elevation myocardial infarction and end-stage renal disease on dialysis:insight from the national inpatient sample[J]. Cardiovasc Revasc Med,2020,21(12):1474-1481.

[17] Panchal HB,Zheng S,Devani K,et al. Impact of chronic kidney disease on revascularization and outcomes in patients with ST-elevation myocardial infarction[J]. Am J Cardiol,2021,150:15-23.

[18] Schmucker J,Fach A,Osteresch R,et al. Temporal trends in treatment strategies and clinical outcomes among patients with advanced chronic kidney disease and ST-elevation myocardial infarctions:results from the Bremen STEMI registry[J]. BMC Cardiovasc Disord,2022,22(1):142.

[19] Vuurmans T,Er L,Sirker A,et al. Long-term patient and kidney survival after coronary artery bypass grafting,percutaneous coronary intervention,or medical therapy for patients with chronic kidney disease:a propensity-matched cohort study[J]. Coron Artery Dis,2018,29(1):8-16.

[20] Yang YG,Li N,Chen MH. Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention:a meta-analysis of propensity score-matching studies[J]. Ren Fail,2021,43(1):606-616.

[21] Li X,Xiao F,Zhang S. Coronary revascularisation in patients with chronic kidney disease and end-stage renal disease:a meta-analysis[J]. Int J Clin Pract,2021,75(11):e14506.

[22] Chen X,Zhang X,Yan Y,et al. The better option of revascularization in complex coronary artery disease patients complicate with chronic kidney disease:a review and meta-analysis[J]. Curr Probl Cardiol,2021,46(9):100886.

[23] Chang TI,Shilane D,Kazi DS,et al. Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD[J]. J Am Soc Nephrol,2012,23(12):2042-2049.

[24] Wu P,Luo F,Fang Z. Multivessel coronary revascularization strategies in patients with chronic kidney disease:a meta-analysis[J]. Cardiorenal Med,2019,9(3):145-159.

[25] Ismail MD,Jalalonmuhali M,Azhari Z,et al. Outcomes of STEMI patients with chronic kidney disease treated with percutaneous coronary intervention:the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention(NCVD-PCI) registry data from 2007 to 2014[J]. BMC Cardiovasc Disord,2018,18(1):184.

[26] Luo L,Xu WQ,Zhong RX,et al. Clinical efficacy and safety of percutaneous coronary intervention for acute myocardial infarction complicated with chronic renal insufficiency:a protocol of systematic review and meta-analysis[J]. Medicine,2019,98(24):e16005.

[27] Ku?ma ?,Ma?yszko J,Kurasz A,et al. Impact of renal function on patients with acute coronary syndromes:15,593 patient-years study[J]. Ren Fail,2020,42(1):881-889.

[28] Lawton JS,Tamis-Holland JE,Bangalore S,et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation,2022,145(3):e18-e114.

[29] Fu Y,Sun H,Zuo K,et al. Patients with end-stage renal disease requiring hemodialysis benefit from percutaneous coronary intervention after non-ST-segment elevation myocardial infarction[J]. Intern Emerg Med,2022,17(4):1087-1095.

[30] Bhatia S,Arora S,Bhatia SM,et al. Non-ST-segment-elevation myocardial infarction among patients with chronic kidney disease:a propensity score-matched comparison of percutaneous coronary intervention versus conservative management[J]. J Am Heart Assoc,2018,7(6):e007920.

[31] Sharon A,Massalha E,Fishman B,et al. Early invasive strategy and outcome of?non-ST-segment elevation myocardial?infarction patients with?chronic?kidney disease[J]. JACC Cardiovasc Interv,2022,15(19):1977-1988.

[32] Collet JP,Thiele H,Barbato E,et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J]. Eur Heart J,2021,42(14):1289-1367.

[33] Shaw C,Nitsch D,Lee J,et al. Impact of an early invasive strategy versus conservative strategy for unstable angina and non-ST elevation acute coronary syndrome in patients with chronic kidney disease:a systematic review[J]. PLoS One,2016,11(5):e0153478.

[34] Holper EM,Addo T. Clinical implications of the BARI 2D and COURAGE trials:the evolving role of percutaneous coronary intervention[J]. Coron Artery Dis,2010,21(7):397-401.

[35] de Bruyne B,Pijls NH,Kalesan B,et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease[J]. N Engl J Med,2012,367(11):991-1001.

[36] Bangalore S,Maron DJ,Fleg JL,et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches-Chronic Kidney Disease(ISCHEMIA-CKD):rationale and design[J]. Am Heart J,2018,205:42-52.

[37] Manske CL,Wang Y,Rector T,et al. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure[J]. Lancet,1992,340(8826):998-1002.

[38] Bangalore S,Maron DJ,O’Brien SM,et al. Management of coronary disease in patients with advanced kidney disease[J]. N Engl J Med,2020,382(17):1608-1618.

[39] Knuuti J,Wijns W,Saraste A,et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes[J]. Eur Heart J,2020,41(3):407-477.

[40] Shibata K,Wakabayashi K,Kosaki R,et al. Ultra-minimum contrast percutaneous coronary intervention for a patient with complex coronary artery disease and end-stage diabetic nephropathy[J]. J Cardiol Cases,2021,23(6):290-293.

[41] Sacha J,Gierlotka M,Lipski P,et al. Zero-contrast percutaneous coronary interventions to preserve kidney function in patients with severe renal impairment and hemodialysis subjects[J]. Postepy Kardiol Interwencyjnej,2019,15(2):137-142.

[42] Shah R,Wood SJ,Khan SA,et al. High-volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast-induced nephropathy:a meta-analysis of randomized trials[J]. Clin Cardiol,2017,40(12):1242-1246.

相似文献/References:

[1]赵丹 周鹏.达比加群及其逆转剂在心血管疾病中的研究进展[J].心血管病学进展,2019,(5):801.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.034]
　ZHAO DanZHOU Peng.Dabigatran and Reversal in Cardiovascular Diseases[J].Advances in Cardiovascular Diseases,2019,(7):801.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.034]
[2]陈元 楚天舒 武力勇.瘦素抵抗、瘦素受体基因多态性与冠状动脉粥样硬化性心脏病的相关性进展[J].心血管病学进展,2019,(8):1130.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.015]
　CHEN Yuan,CHU Tianshu,WU Liyong.Leptin Resistance,Leptin Receptor Gene Polymorphism and Coronary Atherosclerotic Heart Disease[J].Advances in Cardiovascular Diseases,2019,(7):1130.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.015]
[3]石文坚 花蕾 孟祥光 袁义强.环状RNA在冠状动脉粥样硬化性心脏病中的研究进展[J].心血管病学进展,2019,(9):1286.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.026]
　SHI Wenjian,HUA Lei,MENG Xiangguang,et al.CircRNA in Coronary Atherosclerotic Heart Disease[J].Advances in Cardiovascular Diseases,2019,(7):1286.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.026]
[4]孙涛 左权 周辉 刘安康 梁诚 汤圣兴.末梢桡动脉和无鞘技术在冠状动脉介入治疗中的应用现状[J].心血管病学进展,2020,(5):456.[doi:10.16806/j.cnki.issn.1004-3934.2020.05.005]
[5]奚云萍 臧雁翔 李为民.临床SYNTAX计分及其衍生计分在冠心病血运重建预后中的应用价值[J].心血管病学进展,2020,(5):452.[doi:10.16806/j.cnki.issn.1004-3934.2020.05.004]
　XI Yunping,ZANG Yanxiang,LI Weimin.Value of Clinical SYNTAX Score and Its Derivative Score in Prognosis of Coronary Artery Disease with Revascularization[J].Advances in Cardiovascular Diseases,2020,(7):452.[doi:10.16806/j.cnki.issn.1004-3934.2020.05.004]
[6]肖亚楠 高传玉 朱中玉.低剂量替格瑞洛在冠心病中的应用前景[J].心血管病学进展,2020,(7):706.[doi:10.16806/j.cnki.issn.1004-3934.2020.07.009]
　XIAO Yanan,GAO Chuanyu,ZHU Zhongyu.Application Prospects of Low-dose Ticagrelor in Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2020,(7):706.[doi:10.16806/j.cnki.issn.1004-3934.2020.07.009]
[7]史云聪,王立立 郭艺芳.维生素D与心血管疾病相关性研究进展[J].心血管病学进展,2020,(8):826.[doi:10.16806/j.cnki.issn.1004-3934.20.08.011]
　SHI YuncongWANG LiliGUO Yifang.Vitamin D And Cardiovascular Disease[J].Advances in Cardiovascular Diseases,2020,(7):826.[doi:10.16806/j.cnki.issn.1004-3934.20.08.011]
[8]李英  刘兴鹏.常见心血管病服药依从性[J].心血管病学进展,2020,(10):1016.[doi:10.16806/j.cnki.issn.1004-3934.2020.10.000]
　LI Ying,LIU Xingpeng.Medication Adherence For Common Cardiovascular Diseases[J].Advances in Cardiovascular Diseases,2020,(7):1016.[doi:10.16806/j.cnki.issn.1004-3934.2020.10.000]
[9]肖亚楠 高传玉.经皮冠脉介入术后短程双联抗血小板治疗的研究进展[J].心血管病学进展,2021,(4):318.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.008]
　XIAO Yanan,GAO Chuanyu.Short-term Dual Antiplatelet Therapy after Percutaneous Coronary Intervention[J].Advances in Cardiovascular Diseases,2021,(7):318.[doi:10.16806/j.cnki.issn.1004-3934.2021.04.008]
[10]吉蓉 寿锡凌.秋水仙碱在冠状动脉粥样硬化性心脏病防治中的研究进展与争议[J].心血管病学进展,2022,(1):60.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.016]
　JI Rong,SHOU Xiling.Research Progress and Controversy of Colchicine in Prevention and Treatment of Coronary Atherosclerotic Heart Disease[J].Advances in Cardiovascular Diseases,2022,(7):60.[doi:10.16806/j.cnki.issn.1004-3934.2022.01.016]

更新日期/Last Update: 2023-08-18