Department of Cardiology, Medical University, Bialystok, Poland.
Kardiol Pol. 2011;69(1):33-9.
The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal.
To evaluate the incidence of anaemia and its impact on early outcomes in patients undergoing primary PCI for STEMI.
Based on a retrospective review of the medical records of hospitalised patients we selected a study group comprising 551 consecutive patients with STEMI, including 164 females, mean age 63.4 ± 12 years, undergoing primary PCI within the first 12 hours after the onset of chest pain. Anaemia was diagnosed according to the World Health Organisation criteria based on haemoglobin (Hb) values on admission (〈 12 g/dL for females, 〈 13 g/dL for males).
Anaemia was diagnosed in 61 (11%) patients (in 13% of females and 10% of males). The anaemic patients were older (71 vs 63 years, p 〈 0.001), had a lower body mass (70 vs 80 kg, p 〈 0.003) and a higher TIMI risk score for STEMI (5 vs 3, p 〈 0.0001). Their laboratory results showed a greater renal impairment (GFR 66.8 vs 75.8 mL/min, p 〈 0.008) and higher C-reactive protein levels (24.8 vs 14.4 mg/L, p 〈 0.001). There were no significant differences in post-infarction myocardial damage as estimated on the basis of ejection fraction and the baseline and peak CK-MB levels. During treatment, in both groups, there was a significant decrease in Hb levels from 11.9 to 11.0 g/dL in the anaemic patients (p 〈 0.0004) and from 14.3 to 13.3 g/dL in the non-anaemic patients (p 〈 0.001). While GFR did not change significantly in the anaemic patients, there was a significant increase in the non-anaemic patients from 75.8 to 80.9 mL/min (p 〈 0.001). The in-hospital mortality was low with a total of 8 (1.3%) patients dying: 5 (8.2%) in the anaemic group and 3 (0.6%) in the non-anaemic group (p 〈 0.001). The anaemic patients were also characterised by a higher incidence of cardiovascular complications (33% vs 17%, p = 0.003). In the multivariate analysis, older age, systolic blood pressure on admission and elevated white blood count were independently associated with a higher risk of death and cardiovascular complications, whereas baseline Hb level was a significant prognostic factor only in the univariate analysis.
Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor.
近期，基础贫血对急性冠状动脉综合征的发生和病程的影响已成为广泛研究的课题。ST 段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）时贫血意义的数据较少，且结论不一。
评估 STEMI 患者行直接 PCI 时贫血的发生率及其对早期结局的影响。
基于对住院患者病历的回顾性分析，我们选择了 551 例连续 STEMI 患者作为研究对象，其中包括 164 例女性，平均年龄 63.4±12 岁，胸痛发作后 12 小时内行直接 PCI。根据血红蛋白（Hb）值入院时诊断贫血（女性＜12g/dL，男性＜13g/dL）。
诊断为贫血的患者有 61 例（11%）（女性中占 13%，男性中占 10%）。贫血患者年龄更大（71 岁 vs 63 岁，p＜0.001），体重更轻（70kg vs 80kg，p＜0.003），STEMI 的 TIMI 危险评分更高（5 分 vs 3 分，p＜0.0001）。他们的实验室结果显示肾功能损害更严重（GFR 为 66.8ml/min vs 75.8ml/min，p＜0.008）和 C 反应蛋白水平更高（24.8mg/L vs 14.4mg/L，p＜0.001）。根据射血分数以及基础和峰值 CK-MB 水平估计的心肌梗死后损伤无显著差异。在治疗期间，两组患者的 Hb 水平均显著下降，贫血患者从 11.9g/dL 降至 11.0g/dL（p＜0.0004），非贫血患者从 14.3g/dL 降至 13.3g/dL（p＜0.001）。贫血患者的 GFR 无显著变化，而非贫血患者从 75.8ml/min 增加至 80.9ml/min（p＜0.001）。住院死亡率较低，共有 8 例（1.3%）患者死亡：贫血组 5 例（8.2%），非贫血组 3 例（0.6%）（p＜0.001）。贫血患者还具有更高心血管并发症发生率（33% vs 17%，p=0.003）的特点。多变量分析显示，年龄较大、入院时收缩压和白细胞计数升高与死亡和心血管并发症风险增加独立相关，而基线 Hb 水平仅在单变量分析中是一个显著的预后因素。
发生 STEMI 的贫血患者入院时即为一个独立的、风险更高的患者群体，其死亡和院内心血管并发症风险显著增加。贫血对接受 PCI 的急性 MI 患者结局的不利影响较为复杂，不能用梗死后心肌损伤的程度来解释。在 STEMI 患者中，入院时的贫血应被视为一个额外的危险因素。
