Kalra Paul R, Greenlaw Nicola, Ferrari Roberto, Ford Ian, Tardif Jean-Claude, Tendera Michal, Reid Christopher M, Danchin Nicolas, Stepinska Janina, Steg Ph Gabriel, Fox Kim M
Portsmouth Hospital NHS Trust, Portsmouth and NHLI Imperial College, London, United Kingdom.
Robertson Centre, University of Glasgow, Scotland.
Am J Med. 2017 Jun;130(6):720-730. doi: 10.1016/j.amjmed.2017.01.002. Epub 2017 Jan 19.
Anemia is a predictor of adverse outcomes in acute myocardial infarction. We studied the relationship of hemoglobin, or its change over time, and outcomes in patients with stable coronary artery disease.
The ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease is a prospective, cohort study of outpatients with stable coronary artery disease (32,901 in 45 countries 2009-2010): 21,829 with baseline hemoglobin levels. They were divided into hemoglobin quintiles and anemia status (anemic or normal at baseline/follow-up: normal/normal; anemic/normal; normal/anemic; anemic/anemic. All-cause mortality, cardiovascular events, and major bleeding at 4-year follow-up were assessed.
Low baseline hemoglobin was an independent predictor of all-cause, cardiovascular, and noncardiovascular mortality, the composite of cardiovascular death/myocardial infarction or stroke and major bleeds (all P <.001; unadjusted models). Anemia at follow-up was independently associated with all-cause mortality (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.55-2.33 for anemic/anemic; 1.87; 1.54-2.28 for normal/anemic; both P <.001), noncardiovascular mortality (P <.001), and cardiovascular mortality (P = .001). Patients whose baseline anemia normalized (anemic/normal) were not at increased risk of death (HR, 1.02; 95% CI, 0.77-1.35), although the risk of major bleeding was greater (HR, 2.06; 95% CI, 1.23-3.44; P = .013) than in those with normal hemoglobin throughout. Sensitivity analyses excluding patients with heart failure and chronic kidney disease at baseline yielded qualitatively similar results.
In this large population with stable coronary artery disease, low hemoglobin was an independent predictor of mortality, cardiovascular events, and major bleeds. Persisting or new-onset anemia is a powerful predictor of cardiovascular and noncardiovascular mortality.
贫血是急性心肌梗死不良预后的一个预测指标。我们研究了血红蛋白及其随时间的变化与稳定型冠状动脉疾病患者预后的关系。
稳定型冠状动脉疾病患者前瞻性纵向注册研究是一项对稳定型冠状动脉疾病门诊患者的前瞻性队列研究（2009 - 2010年在45个国家的32,901例患者）：其中21,829例有基线血红蛋白水平。他们被分为血红蛋白五分位数组和贫血状态组（基线/随访时贫血或正常：正常/正常；贫血/正常；正常/贫血；贫血/贫血）。评估了4年随访时的全因死亡率、心血管事件和大出血情况。
低基线血红蛋白是全因、心血管和非心血管死亡率、心血管死亡/心肌梗死或中风与大出血复合事件的独立预测指标（所有P <.001；未校正模型）。随访时贫血与全因死亡率（风险比[HR]，1.90；95%置信区间[CI]，贫血/贫血组为1.55 - 2.33；正常/贫血组为1.87；1.54 - 2.28；两者P <.001）、非心血管死亡率（P <.001）和心血管死亡率（P =.001）独立相关。基线贫血恢复正常（贫血/正常）的患者死亡风险未增加（HR，1.02；95% CI，0.77 - 1.35），尽管大出血风险高于血红蛋白始终正常的患者（HR，2.06；95% CI，1.23 - 3.44；P =.013）。排除基线时有心力衰竭和慢性肾脏病患者的敏感性分析得出了定性相似的结果。
在这个稳定型冠状动脉疾病的大样本人群中，低血红蛋白是死亡率、心血管事件和大出血的独立预测指标。持续性或新发贫血是心血管和非心血管死亡率的有力预测指标。
