Sabatine Marc S, Morrow David A, Giugliano Robert P, Burton Paul B J, Murphy Sabina A, McCabe Carolyn H, Gibson C Michael, Braunwald Eugene
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA.
Circulation. 2005 Apr 26;111(16):2042-9. doi: 10.1161/01.CIR.0000162477.70955.5F. Epub 2005 Apr 11.
In the setting of an acute coronary syndrome (ACS), anemia has the potential to worsen myocardial ischemia; however, data relating anemia to clinical outcomes in ACS remain limited.
We examined the association between baseline hemoglobin values and major adverse cardiovascular events through 30 days in 39,922 patients enrolled in clinical trials of ACS. After adjustment for differences in baseline characteristics and index hospitalization treatments, a reverse J-shaped relationship between baseline hemoglobin values and major adverse cardiovascular events was observed. In patients with ST-elevation myocardial infarction, when those with hemoglobin values between 14 and 15 g/dL were used as the reference, cardiovascular mortality increased as hemoglobin levels fell below 14 g/dL, with an adjusted OR of 1.21 (95% CI 1.12 to 1.30, P<0.001) for each 1-g/dL decrement in hemoglobin. At the other end of the range of hemoglobin, patients with hemoglobin values >17 g/dL also had excess mortality (OR 1.79, 95% CI 1.18 to 2.71, P=0.007). In patients with non-ST-elevation ACS, with those with hemoglobin 15 to 16 g/dL used as the reference, the likelihood of cardiovascular death, myocardial infarction, or recurrent ischemia increased as the hemoglobin fell below 11 g/dL, with an adjusted OR of 1.45 (95% CI 1.33 to 1.58, P<0.001) for each 1 g/dL decrement in hemoglobin. Patients with hemoglobin values >16 g/dL also had an increased rate of death or ischemic events (OR 1.31, 95% CI 1.03 to 1.66, P=0.027).
Anemia is a powerful and independent predictor of major adverse cardiovascular events in patients across the spectrum of ACS.
在急性冠状动脉综合征（ACS）的情况下，贫血有可能加重心肌缺血；然而，关于贫血与ACS临床结局之间关系的数据仍然有限。
我们在39922例参加ACS临床试验的患者中，研究了基线血红蛋白值与30天内主要不良心血管事件之间的关联。在对基线特征和首次住院治疗的差异进行调整后，观察到基线血红蛋白值与主要不良心血管事件之间呈反向J形关系。在ST段抬高型心肌梗死患者中，以血红蛋白值在14至15 g/dL之间的患者为参照，当血红蛋白水平低于14 g/dL时，心血管死亡率增加，血红蛋白每降低1 g/dL，校正后的比值比为1.21（95%可信区间为1.12至1.30，P<0.001）。在血红蛋白范围的另一端，血红蛋白值>17 g/dL的患者也有额外死亡率（比值比1.79，95%可信区间为1.18至2.71，P=0.007）。在非ST段抬高型ACS患者中，以血红蛋白15至16 g/dL的患者为参照，当血红蛋白低于11 g/dL时，心血管死亡、心肌梗死或复发性缺血的可能性增加，血红蛋白每降低1 g/dL，校正后的比值比为1.45（95%可信区间为1.33至1.58，P<0.001）。血红蛋白值>16 g/dL的患者死亡或缺血事件发生率也增加（比值比1.31，95%可信区间为1.03至1.66，P=0.027）。
贫血是ACS患者主要不良心血管事件的一个有力且独立的预测因素。
