Renal Function and Effect of Statin Therapy on Cardiovascular Outcomes in Patients Undergoing Coronary Revascularization (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

被引:30
|
作者
Natsuaki, Masahiro [2 ]
Furukawa, Yutaka [1 ]
Morimoto, Takeshi [4 ]
Sakata, Ryuzo [3 ]
Kimura, Takeshi [2 ]
机构
[1] Gen Hosp, Kobe City Med Ctr, Dept Cardiovasc Med, Kobe, Hyogo, Japan
[2] Kyoto Univ, Dept Cardiovasc Med, Grad Sch Med, Kyoto, Japan
[3] Kyoto Univ, Dept Cardiovasc Surg, Grad Sch Med, Kyoto, Japan
[4] Kinki Univ, Sch Med, Ctr Gen Internal Med & Emergency Care, Osaka 589, Japan
来源
AMERICAN JOURNAL OF CARDIOLOGY | 2012年 / 110卷 / 11期
关键词
CHRONIC KIDNEY-DISEASE; DENSITY-LIPOPROTEIN CHOLESTEROL; TYPE-2; DIABETES-MELLITUS; C-REACTIVE PROTEIN; HEART-DISEASE; PREVENTION; EVENTS; ROSUVASTATIN; ATORVASTATIN; HEMODIALYSIS;
D O I
10.1016/j.amjcard.2012.07.021
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Although statin therapy is essential for secondary cardiovascular prevention, the therapeutic effect of statins on cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated. In the CREDO-Kyoto Registry Cohort-2, 14,706 patients who underwent first coronary revascularization were divided into 4 strata based on estimated glomerular filtration rate (eGFR) or status of hemodialysis (HD). Patients in each stratum were further divided into 2 groups based on statin therapy at discharge: non-CKD stratum (eGFR >= 60 ml/min/1.73 m(2)), 8,959 patients (statin, n = 4,747; no statin, n = 4,212); mild CKD stratum (eGFR >= 30 to <60 ml/min/1.73 m(2)), 4,567 patients (statin, n = 2,135; no statin, n = 2,432); severe CKD stratum (eGFR <30 ml/min/1.73 m(2)), 608 patients (statin, n = 229; no statin, n = 379); and HD stratum, 572 patients (statin, n = 117; no statin, n = 455). Median follow-up duration was 956 days (interquartile range 699 to 1,245). Adjusted risk for major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, or stoke) was significantly lower in the statin group than in the no-statin group in the non-CKD (hazard ratio 0.8, 95% confidence interval 0.68 to 0.95, p = 0.01) and mild CKD (hazard ratio 0.69, 95% confidence interval 0.56 to 0.84, p = 0.0002) strata. However, a significant association of statin therapy and lower risk for MACEs was not seen in the severe CKD (hazard ratio 0.91, 95% confidence interval 0.6 to 1.38, p = 0.65) and HD (hazard ratio 1.04, 95% confidence interval 0.64 to 1.69, p = 0.87) strata. In conclusion, statin therapy was associated with significantly lower risk for MACEs in patients with non-CKD and mild CKD undergoing coronary revascularization. However, therapeutic benefits of statins were not apparent in patients with severe CKD and HD. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1568-1577)
引用
收藏
页码:1568 / 1577
页数:10
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