Oshin O A, Torella F
Liverpool Vascular and Endovascular Service, University Hospital Aintree, Liverpool, United Kingdom.
Vasc Endovascular Surg. 2013 Aug;47(6):449-53. doi: 10.1177/1538574413493679. Epub 2013 Jun 21.
To assess the influence of low hemoglobin (Hb) concentration on major adverse cardiac events (MACE) and mortality in patients undergoing peripheral arterial surgery.
This was a retrospective cohort study of patients undergoing peripheral arterial reconstructive surgery at a tertiary vascular center. Preoperative factors linked with the occurrence of MACE and death on univariate analysis (P ≤ .1) were included in a multivariate model to confirm the independent association with the outcome variables.
A total of 360 consecutive patients (238 men) with a mean (standard deviation) age of 69 (10.7) years and Hb of 13.0 (2.12) g/dL treated under the care of a single specialist between January 2004 and December 2011 were included in the analysis. Of these, 193 (53.6%) were anemic. In all, 26 (7%) had a postoperative MACE and 18 (5%) died. On multivariate analysis, age > 80 years (odds ratio [OR] = 3; 95% confidence interval [CI] [1.2-7.5]; P = .025), renal impairment (OR = 3.2; 95% CI [.99-10.2]; P = .053), coronary disease (OR = 3.6; 95% CI [1.5-8.7]; P = .005), and low Hb (OR for each 1 g/dL drop below the mean = 1.4 [1.13-1.7]; P = .002) were independent risk factors for MACE. Unplanned surgery (OR = 4.5; 95% CI [1.2-16.9]; P = .025) and low Hb (OR for each 1 g/dL drop below the mean = 1.5; 95% CI [1.14-1.86]; P = .002) were independent risk factors for death.
In peripheral arterial surgery, preoperative low Hb is associated with MACE and death. Further investigation is necessary to elucidate whether this relationship is causal. Meanwhile, consideration should be given to treating preoperative anemia as a significant risk factor for adverse outcome in this setting.
评估低血红蛋白（Hb）浓度对接受外周动脉手术患者的主要不良心脏事件（MACE）和死亡率的影响。
这是一项对在三级血管中心接受外周动脉重建手术患者的回顾性队列研究。单因素分析中与MACE发生和死亡相关的术前因素（P≤0.1）被纳入多变量模型，以确认与结局变量的独立关联。
分析纳入了2004年1月至2011年12月期间由一名专科医生治疗的360例连续患者（238例男性），平均（标准差）年龄为69（10.7）岁，Hb为13.0（2.12）g/dL。其中，193例（53.6%）为贫血患者。共有26例（7%）发生术后MACE，18例（5%）死亡。多变量分析显示，年龄>80岁（比值比[OR]=3；95%置信区间[CI][1.2 - 7.5]；P = 0.025）、肾功能损害（OR = 3.2；95% CI[0.99 - 10.2]；P = 0.053）、冠心病（OR = 3.6；95% CI[1.5 - 8.7]；P = 0.005）以及低Hb（每低于平均值1 g/dL的OR = 1.4[1.13 - 1.7]；P = 0.002）是MACE的独立危险因素。非计划手术（OR = 4.5；95% CI[1.2 - 16.9]；P = 0.025）和低Hb（每低于平均值1 g/dL的OR = 1.5；95% CI[1.14 - 1.86]；P = 0.002）是死亡的独立危险因素。
在外周动脉手术中，术前低Hb与MACE和死亡相关。有必要进一步研究以阐明这种关系是否为因果关系。同时，应考虑将术前贫血视为该情况下不良结局的重要危险因素。
