Muzzarelli Stefano, Pfisterer Matthias
Division of Cardiology, University Hospital, Basel, Switzerland.
Am Heart J. 2006 Nov;152(5):991-6. doi: 10.1016/j.ahj.2006.06.014.
Anemia correlates with worse outcome in patients with heart failure, after myocardial infarction or angioplasty. Its prevalence increases with age, but the influence of anemia on outcome of elderly patients with stable symptomatic coronary artery disease (CAD) is unknown. Therefore, we assessed the impact of anemia on long-term outcome in elderly patients with CAD.
Hemoglobin-related outcome was examined in 253 patients of the TIME study. Patients > or = 75 years old were randomly assigned to an invasive or optimized medical strategy and followed for a median of 4 years for death, nonfatal myocardial infarction, or hospitalization for CAD. Depending on their hemoglobin (Hb) level, patients were divided in quartiles (Q). Anemia was defined as Hb < 13 g/dL for men and < 12 g/dL for women.
Compared with nonanemic patients, those with previously unknown anemia were older (79 +/- 3 vs 80 +/- 4 years, P < .01), had more chronic renal failure (6.7% vs 26.4%, P < .01), diabetes (18.9% vs 30.1%, P = .05), and were more likely to have > 2 comorbidities (21.7% vs 38.4%, P < .01). After adjustment for baseline differences, a decrease in 1 g/dL Hb increased the risk of all-cause death by 34% (adjusted risk ratio 1.34, P < .01), of cardiac death by 28% (adjusted risk ratio 1.28, P = .02), and of major adverse clinical events in patients with Hb levels < 13.3 g/dL by 23% (adjusted risk ratio 1.23, P = .01).
Anemia proved to be an independent predictor of death and major clinical adverse events among elderly patients with stable symptomatic CAD.
贫血与心力衰竭、心肌梗死或血管成形术后患者的不良预后相关。其患病率随年龄增长而增加，但贫血对老年稳定型症状性冠状动脉疾病（CAD）患者预后的影响尚不清楚。因此，我们评估了贫血对老年CAD患者长期预后的影响。
在TIME研究的253例患者中检查了与血红蛋白相关的预后情况。年龄≥75岁的患者被随机分配至侵入性或优化药物治疗策略组，并随访4年，观察死亡、非致死性心肌梗死或因CAD住院情况。根据血红蛋白（Hb）水平，将患者分为四分位数（Q）。贫血定义为男性Hb<13 g/dL，女性Hb<12 g/dL。
与非贫血患者相比，既往未知贫血的患者年龄更大（79±3岁 vs 80±4岁，P<.01），慢性肾衰竭更多（6.7% vs 26.4%，P<.01），糖尿病更多（18.9% vs 30.1%，P=.05），且更可能有>2种合并症（21.7% vs 38.4%，P<.01）。在对基线差异进行校正后，Hb每降低1 g/dL，全因死亡风险增加34%（校正风险比1.34，P<.01），心源性死亡风险增加28%（校正风险比1.28，P=.02），Hb水平<13.3 g/dL患者的主要不良临床事件风险增加23%（校正风险比1.23，P=.01）。
贫血被证明是老年稳定型症状性CAD患者死亡和主要临床不良事件的独立预测因素。
