无限制使用药物洗脱支架血运重建患者贫血对长期临床结局的影响。
The impact of anemia on long-term clinical outcome in patients undergoing revascularization with the unrestricted use of drug-eluting stents.
机构信息
Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
出版信息
Circ Cardiovasc Interv. 2012 Apr;5(2):202-10. doi: 10.1161/CIRCINTERVENTIONS.111.965749. Epub 2012 Mar 27.
BACKGROUND
Anemia is frequent among patients with cardiovascular disease and adversely affects prognosis. The objective of this analysis was to assess the impact of anemia on long-term clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with the unrestricted use of drug-eluting stents (DES).
METHODS AND RESULTS
Between April 2002 to March 2009, 6528 consecutive patients underwent PCI with the unrestricted use of DES. Among patients with anemia according to the criteria by the World Health Organization (WHO) (hemoglobin <130 g/L for men and <120 g/L for women, respectively) patients below the 25(th) percentile separately for men and women were defined to have severe anemia. We compared clinical outcomes among patients with severe anemia and no/mild anemia during long-term follow-up through 4 years. Whereas 21.6% of patients were found to have anemia according to the WHO definition, 347 patients (5.5%) had severe anemia (mean hemoglobin, 98±11 g/L). Severe anemia was more prevalent among the elderly (P<0.001), diabetics (P<0.001), and patients with chronic kidney disease (P<0.001). In adjusted analyses, severe anemia was associated with an increased risk of death (hazard ratio, 1.86; 95% confidence interval, 1.37-2.52; P<0.0001), cardiac death (hazard ratio, 2.32; 95% confidence interval, 1.57-3.43; P<0.0001), and myocardial infarction (hazard ratio, 2.02; 95% confidence interval, 1.36-3.01; P=0.00054) as compared with no/mild anemia without significant interaction across sexes (P=0.86) and acute coronary syndromes (P=0.61) and a trend toward a particularly high risk of mortality among anemic patients <65 years of age (P=0.07). Severe anemia resulted in a greater risk of overall definite stent thrombosis (hazard ratio, 2.59; 95% confidence interval, 1.48-4.54; P=0.00089).
CONCLUSIONS
Severe anemia is common among patients undergoing PCI with the unrestricted use of DES and adversely affects long-term prognosis, including survival.
背景
贫血是心血管疾病患者常见的问题，并对预后产生不利影响。本分析的目的是评估在无限制使用药物洗脱支架（DES）的经皮冠状动脉介入治疗（PCI）患者中，贫血对长期临床结局的影响。
方法和结果
2002 年 4 月至 2009 年 3 月，连续 6528 例患者接受了无限制使用 DES 的 PCI。根据世界卫生组织（WHO）的标准（男性血红蛋白<130 g/L，女性血红蛋白<120 g/L），将贫血患者分为轻度贫血和重度贫血。对于男性和女性分别低于第 25 百分位数的患者定义为重度贫血。通过 4 年的长期随访，我们比较了重度贫血和非/轻度贫血患者的临床结局。根据 WHO 定义，21.6%的患者存在贫血，347 例（5.5%）患者存在重度贫血（平均血红蛋白 98±11 g/L）。重度贫血更常见于老年人（P<0.001）、糖尿病患者（P<0.001）和慢性肾脏病患者（P<0.001）。在调整分析中，重度贫血与死亡风险增加相关（风险比 1.86；95%置信区间 1.37-2.52；P<0.0001）、心脏性死亡（风险比 2.32；95%置信区间 1.57-3.43；P<0.0001）和心肌梗死（风险比 2.02；95%置信区间 1.36-3.01；P=0.00054），而非/轻度贫血患者无显著性别间交互作用（P=0.86）和急性冠脉综合征（P=0.61）。对于年龄<65 岁的贫血患者，死亡率呈升高趋势（P=0.07）。重度贫血与全因明确支架血栓形成风险增加相关（风险比 2.59；95%置信区间 1.48-4.54；P=0.00089）。
结论
在无限制使用 DES 的 PCI 患者中，重度贫血较为常见，并且对长期预后产生不利影响，包括生存率。
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