Ferreira Muriel, António Natália, Gonçalves Francisco, Monteiro Pedro, Gonçalves Lino, Freitas Mário, Providência Luís Augusto
Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Rev Port Cardiol. 2012 Feb;31(2):121-31. doi: 10.1016/j.repc.2011.12.013. Epub 2012 Jan 11.
Anemia has been shown to be associated with a worse prognosis, especially higher mortality in various pathological conditions. However, few studies have specifically examined its impact in acute coronary syndrome (ACS) patients. The purpose of our study was to assess the association between different quartiles of hemoglobin on admission and short- and long-term prognosis in patients with ACS.
We performed a retrospective analysis of 1303 consecutive ACS patients admitted to a coronary care unit and analyzed the association between baseline hemoglobin and morbidity and mortality, in-hospital and at 12-month follow-up. The population was divided into groups according to quartiles of hemoglobin concentration (Hb): Q1: <10.8g/dl; Q2: 10.8-12.2g/dl; Q3: 12.3-13.2g/dl; Q4: ≥13.3g/dl. Logistic regression analysis was used to identify independent predictors of short- and long-term mortality.
Hypertension and diabetes mellitus were more common in the lower Hb quartiles, while the prevalence of smoking and physical inactivity increased with higher Hb. A higher proportion of patients in the lower quartiles had congestive heart failure, peripheral artery disease and previous stroke or transient ischemic attack. Anemic patients tended to be older, with worse renal function and left ventricular systolic function. Patients in Q1 had significantly higher levels of troponin I and blood glucose on admission. Anemic patients showed significantly higher in-hospital mortality (Q1: 9.8%; Q2: 6.3%; Q3: 4.1%; Q4: 3.6%, p<0.001), longer hospital stay (Q1: 6.1±4.4; Q2: 5.2±3.0; Q3: 4.9±2.7; Q4 4.3±2.1 days, p<0.001) and higher 1-year mortality (Q1: 23.6%; Q2: 11.6%; Q3: 10.6%; Q4: 5.5%, p<0.001). In multivariate analysis, the only independent predictor of in-hospital mortality was Killip class >1 at admission. The independent predictors of long-term mortality were age ≥69.5 years, Killip class >1 at admission, diabetes mellitus, ST-segment depression on admission ECG and Hb <10.8g/dl.
Low baseline hemoglobin is associated with more comorbidities and can accurately predict 1-year mortality after an acute coronary syndrome.
贫血已被证明与较差的预后相关，尤其是在各种病理状况下死亡率更高。然而，很少有研究专门考察其在急性冠脉综合征（ACS）患者中的影响。我们研究的目的是评估入院时血红蛋白不同四分位数与ACS患者短期和长期预后之间的关联。
我们对1303例连续入住冠心病监护病房的ACS患者进行了回顾性分析，并分析了基线血红蛋白与住院期间及12个月随访时的发病率和死亡率之间的关联。根据血红蛋白浓度（Hb）的四分位数将人群分为几组：Q1：<10.8g/dl；Q2：10.8 - 12.2g/dl；Q3：12.3 - 13.2g/dl；Q4：≥13.3g/dl。采用逻辑回归分析来确定短期和长期死亡率的独立预测因素。
高血压和糖尿病在较低Hb四分位数组中更为常见，而吸烟和缺乏身体活动的患病率随着Hb升高而增加。较低四分位数组中有更高比例的患者患有充血性心力衰竭、外周动脉疾病以及既往有中风或短暂性脑缺血发作。贫血患者往往年龄更大，肾功能和左心室收缩功能更差。Q1组患者入院时肌钙蛋白I和血糖水平显著更高。贫血患者的住院死亡率显著更高（Q1：9.8%；Q2：6.3%；Q3：4.1%；Q4：3.6%，p<0.001），住院时间更长（Q1：6.1±4.4；Q2：5.2±3.0；Q3：4.9±2.7；Q4 4.3±2.1天，p<0.001），1年死亡率更高（Q1：23.6%；Q2：11.6%；Q3：10.6%；Q4：5.5%，p<0.001）。在多变量分析中，住院死亡率的唯一独立预测因素是入院时Killip分级>1。长期死亡率的独立预测因素是年龄≥69.5岁、入院时Killip分级>1、糖尿病、入院心电图ST段压低以及Hb<10.8g/dl。
低基线血红蛋白与更多合并症相关，并且可以准确预测急性冠脉综合征后的1年死亡率。
