Đặc điểm tổn thương động mạch vành và thay đổi mức lọc cầu thận sau chụp hoặc can thiệp động mạch vành qua da ở bệnh nhân bệnh thận mạn

Abstract

Introduction: Coronary artery disease is the leading cause of death in patients with chronic kidney disease. Despite many advances in diagnosis and treatment, percutaneous coronary intervention in patients with chronic kidney disease remains challenging.Objectives: (1) Describe clinical, subclinical and coronary artery lesions in patients with chronic kidney disease requiring percutaneous coronary angiography at the Vietnam Heart Institute. (2) Evaluation the changes in clinical, laboratory and glomerular filtration rate after coronary angiography or intervention in thesse patients.Subjects and methods: A descriptive prospective study of 59 chronic kidney disease patients assigned to take percutaneous coronary angiography with or without intervention at the Vietnam Heart Institute from August 2020 to October 2021. The study collected and analyzed information of clinical and laboratory characteristics, percutaneous coronary angiography results and changes in renal function after intervention. Result: The average SYNTAX score was 21,9 ± 13,0. Coronary artery lesions accounted for the majority of branches (84.8%), lesions of 1 branch (11.9%). The most common site of injury was the left anterior descending artery (88.1%) followed by the right coronary artery (71.2%) and the circumflex artery (50.8%). The culprit lesions were often complex, type B2 and type C were the most common types (76.2%), followed by type B1 (14.3%), type A (9.5%). The rate of chronic total occlusion was also quitehigh (25.4%), lesions at the bifurcation (25.4%) were less common in left coronary artery (13.6%). 17,3% of patients had complications of acute kidney injury after the intervention, of which the CKD 3 and CKD 4-5 group were accounted for 12.9% and 23.8% of the patients respectively. Of these, 3 patients had to undergo emergency dialysis after the intervention.Conclusion: Coronary artery lesions in patients with chronic kidney disease was often complicated, often with multiple coronary artery lesions and tended to be more severe with the decline of glomerular filtration rate. Percutaneous coronary intervention in patients with chronic kidney disease had safe results in terms of procedures, however, the rate of complications of acute kidney injury was quite high in patients with CKD.