Salisbury Adam C, Alexander Karen P, Reid Kimberly J, Masoudi Frederick A, Rathore Saif S, Wang Tracy Y, Bach Richard G, Marso Steven P, Spertus John A, Kosiborod Mikhail
Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):337-46. doi: 10.1161/CIRCOUTCOMES.110.957050. Epub 2010 May 20.
Anemia is common among patients hospitalized with acute myocardial infarction and is associated with poor outcomes. Less is known about the incidence, correlates, and prognostic implications of acute, hospital-acquired anemia (HAA).
We identified 2909 patients with acute myocardial infarction who had normal hemoglobin (Hgb) on admission in the multicenter TRIUMPH registry and defined HAA by criteria proposed by Beutler and Waalen. We used hierarchical Poisson regression to identify independent correlates of HAA and multivariable proportional hazards regression to identify the association of HAA with mortality and health status. At discharge, 1321 (45.4%) patients had HAA, of whom 348 (26.3%) developed moderate-severe HAA (Hgb <11 g/dL). The incidence of HAA varied significantly across hospitals (range, 33% to 69%; median rate ratio for HAA, 1.13; 95% confidence interval, 1.07 to 1.23, adjusting for patient characteristics). Although documented bleeding was more frequent with more severe HAA, fewer than half of the patients with moderate-severe HAA had any documented bleeding. Independent correlates of HAA included age, female sex, white race, chronic kidney disease, ST-segment elevation myocardial infarction, acute renal failure, use of glycoprotein IIb/IIIa inhibitors, in-hospital complications (cardiogenic shock, bleeding and bleeding severity), and length of stay. After adjustment for GRACE score and bleeding, patients with moderate-severe HAA had higher mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.11 to 2.98 versus no HAA) and poorer health status at 1 year.
HAA develops in nearly half of acute myocardial infarction hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status. Better understanding of how HAA can be prevented and whether its prevention can improve patient outcomes is needed.
贫血在急性心肌梗死住院患者中很常见，且与不良预后相关。关于急性医院获得性贫血（HAA）的发病率、相关因素及预后影响，人们了解较少。
我们在多中心TRIUMPH注册研究中确定了2909例入院时血红蛋白（Hgb）正常的急性心肌梗死患者，并根据Beutler和Waalen提出的标准定义HAA。我们使用分层泊松回归来确定HAA的独立相关因素，并使用多变量比例风险回归来确定HAA与死亡率及健康状况的关联。出院时，1321例（45.4%）患者发生HAA，其中348例（26.3%）发展为中重度HAA（Hgb<11 g/dL）。HAA的发病率在各医院之间差异显著（范围为33%至69%；HAA的中位率比为1.13；95%置信区间为1.07至1.23，对患者特征进行了调整）。虽然中重度HAA患者记录到的出血更为频繁，但中重度HAA患者中记录到有出血的不到一半。HAA的独立相关因素包括年龄、女性、白种人、慢性肾脏病、ST段抬高型心肌梗死、急性肾衰竭、糖蛋白IIb/IIIa抑制剂的使用、院内并发症（心源性休克、出血及出血严重程度）以及住院时间。在对GRACE评分和出血情况进行调整后，中重度HAA患者的死亡率更高（风险比为1.82；95%置信区间为1.11至2.98，与无HAA患者相比），且1年后健康状况更差。
在接受药物治疗或经皮冠状动脉介入治疗的急性心肌梗死住院患者中，近一半会发生HAA，通常无记录到的出血情况，且与更差的死亡率和健康状况相关。需要更好地了解如何预防HAA以及预防HAA是否能改善患者预后。
