Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA.
Am J Cardiol. 2010 May 15;105(10):1385-94. doi: 10.1016/j.amjcard.2010.01.001. Epub 2010 Apr 2.
The aim of this study was to assess the impact of baseline anemia on the outcomes of patients with ST elevation myocardial infarctions who underwent primary percutaneous coronary intervention in relation to contemporary adjunctive antithrombotic therapy and gender. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients were randomized to bivalirudin alone or to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor before primary percutaneous coronary intervention. Outcomes were assessed at 30 days and 1 year according to anemia and gender. Baseline anemia was present in 331 of 3,153 patients (10.5%). Patients with versus without baseline anemia had a more than twofold increase in major bleeding at 30 days (13.5% vs 6.7%, p <0.0001) and at 1 year (14.8% vs 7.2%, p <0.0001), an association that on multivariate analysis was independent of gender. Mortality was significantly higher in men with versus without baseline anemia (4.6% vs 1.8% at 30 days, p = 0.003; 8.9% vs 3.0% at 1 year, p <0.0001) but not in women (5.3% vs 3.6% at 30 days, p = 0.42; 7.5% vs 5.9% at 1 year, p = 0.54). On multivariate analysis, anemia independently predicted 1-year all-cause mortality in men but not in women. Bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor resulted in twofold lower rates of all-cause and cardiac mortality and major bleeding in patients without but not in those with baseline anemia. In conclusion, baseline anemia was associated with increased major bleeding and death in patients with ST elevation myocardial infarctions who underwent primary PCI but was a stronger predictor of early and late mortality in men than in women. Paradoxically, in this post hoc analysis, the reductions in major bleeding and mortality in ST elevation myocardial infarction afforded by bivalirudin occurred primarily in patients without baseline anemia.
本研究旨在评估基线贫血对接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者结局的影响，同时考虑到当代辅助抗栓治疗和性别因素。在 Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction（HORIZONS-AMI）试验中，患者随机接受比伐卢定单药治疗或未分馏肝素加糖蛋白 IIb/IIIa 抑制剂治疗，然后进行直接经皮冠状动脉介入治疗。根据贫血和性别，在 30 天和 1 年时评估结局。3153 例患者中有 331 例（10.5%）存在基线贫血。与无基线贫血患者相比，基线贫血患者在 30 天（13.5%比 6.7%，p<0.0001）和 1 年（14.8%比 7.2%，p<0.0001）时大出血发生率增加了两倍以上，这种关联在多变量分析中独立于性别。男性基线贫血患者的死亡率明显高于无基线贫血患者（30 天：4.6%比 1.8%，p=0.003；1 年：8.9%比 3.0%，p<0.0001），但女性患者无此差异（30 天：5.3%比 3.6%，p=0.42；1 年：7.5%比 5.9%，p=0.54）。多变量分析显示，贫血独立预测男性患者 1 年全因死亡率，但不预测女性患者。与未分馏肝素加糖蛋白 IIb/IIIa 抑制剂相比，比伐卢定治疗可使无基线贫血患者的全因死亡率和心脏性死亡率及大出血发生率降低两倍，但对有基线贫血患者无此作用。总之，基线贫血与接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者大出血和死亡风险增加相关，但与女性相比，贫血是男性患者早期和晚期死亡率的更强预测因素。矛盾的是，在这项事后分析中，比伐卢定治疗降低 ST 段抬高型心肌梗死大出血和死亡率的作用主要见于无基线贫血患者。
