Department of Cardiology, Rabin Medical Center, Petah-Tikva, affiliated with the Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel.
Am J Cardiol. 2010 Feb 15;105(4):435-40. doi: 10.1016/j.amjcard.2009.10.016. Epub 2010 Jan 5.
Anemia is a well-known predictor of a poor outcome in patients with ST-segment elevation myocardial infarction (STEMI). In contrast, data relating erythrocytosis to clinical outcomes in patients with STEMI are limited. Because erythrocytosis predisposes to a prothrombotic state, we hypothesized it would be associated with an increased risk of thrombotic complications in patients with STEMI undergoing primary percutaneous coronary intervention. We studied 1,042 consecutive patients with STEMI who underwent primary percutaneous coronary intervention and were a part of our primary percutaneous coronary intervention registry from 2001 to 2007. Patients with cardiogenic shock and late arrival were excluded. Patients were allocated into 3 groups according to their baseline hematocrit: anemia (<36% for women and <39% for men), normal, erythrocytosis (>46% for women and >47% for men). The clinical outcomes were assessed at 1, 6, and 12 months. The patients with anemia had the greatest clinical risk profile. Patients with erythrocytosis had a lower risk profile than the other 2 groups, except for greater rates of smoking. The mortality rates were greatest among the patients with anemia, followed by the patients with erythrocytosis, who in turn had greater short-term mortality than patients with normal hematocrit. Multivariate analysis, which included patients with erythrocytosis and those with normal hematocrit (excluding the patients with anemia), revealed that erythrocytosis was associated with an odds ratio of 4.3 (95% confidence interval 1.4 to 13, p = 0.01) for 1-month mortality. In conclusion, although not as strong a predictor of mortality as anemia, erythrocytosis might be associated with increased short-term mortality compared to a normal hematocrit. The measurement of hematocrit can be used as a useful prognostic marker in patients with STEMI.
贫血是 ST 段抬高型心肌梗死（STEMI）患者预后不良的一个众所周知的预测因素。相比之下，关于红细胞增多症与 STEMI 患者临床结局的关系的数据有限。由于红细胞增多症容易导致血栓形成状态，我们假设它与 STEMI 患者接受直接经皮冠状动脉介入治疗后血栓并发症的风险增加有关。我们研究了 2001 年至 2007 年期间在我们直接经皮冠状动脉介入治疗登记处接受直接经皮冠状动脉介入治疗的 1042 例连续 STEMI 患者。排除心源性休克和晚期到达的患者。根据基线血细胞比容将患者分为 3 组：贫血（女性<36%，男性<39%）、正常、红细胞增多症（女性>46%，男性>47%）。在 1、6 和 12 个月时评估临床结局。贫血患者的临床风险最大。除吸烟率较高外，红细胞增多症患者的风险特征低于其他两组。贫血患者的死亡率最高，其次是红细胞增多症患者，而他们的短期死亡率又高于血细胞比容正常的患者。多变量分析包括红细胞增多症患者和血细胞比容正常的患者（不包括贫血患者），结果显示红细胞增多症与 1 个月死亡率的比值比为 4.3（95%置信区间为 1.4 至 13，p=0.01）。总之，尽管红细胞增多症不像贫血那样是死亡率的强预测因素，但与正常血细胞比容相比，它可能与短期死亡率增加有关。血细胞比容的测量可作为 STEMI 患者有用的预后标志物。
