2015 AHA科学声明:慢性肾病合并急性冠脉综合征患者的药物治疗
Chronic kidney disease (CKD) is frequently encountered among patients presenting with acute coronary syndrome (ACS). Recent data from the National Cardiovascular Data Registry–Acute Coronary Treatment and Intervention Outcomes Network (NCDR-ACTION) reported CKD (defined as estimated creatinine clearance [CrCl] <60 mL·min−1·1.73 m−2) prevalence rates of 30.5% among patients presenting with ST-segment–elevation myocardial infarction (STEMI) and 42.9% among patients presenting with non–ST-segment–elevation myocardial infarction (NSTEMI). The presence of CKD among patients presenting with ACS has been associated with worse outcomes, including higher rates of mortality and bleeding. Despite the increased risk for adverse outcomes, CKD patients presenting with ACS are less likely to receive evidence-based therapies, including medications.
In addition, patients with CKD have been underrepresented in randomized controlled trials of ACS pharmacotherapy. Thus, the net effect is a relative lack of evidence and potential for uncertainty in selecting medications in this highrisk population. The purpose of this scientific statement is to provide a comprehensive review of the published literature and provide recommendations on the use of evidence-based pharmacotherapies in CKD patients presenting with ACS.
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