Brener Sorin J, Mehran Roxana, Dangas George D, Ohman Edwin Magnus, Witzenbichler Bernhard, Zhang Yiran, Parvataneni Rupa, Stone Gregg W
Department of Medicine, New York Methodist Hospital, Brooklyn, New York.
Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York; Department of Medicine, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Cardiol. 2017 Jun 1;119(11):1710-1716. doi: 10.1016/j.amjcard.2017.02.052. Epub 2017 Mar 16.
The association between anemia at admission and adverse outcomes in patients with acute coronary syndrome (ACS) has been incompletely studied. Anemia was defined as serum hemoglobin <12 g/dl in women or <13 g/dl in men in 2 large trials of patients with ACS. We plotted hazard functions for major bleeding at 30 days and all-cause mortality, myocardial infarction, and stent thrombosis at 1 year according to baseline hemoglobin. Among 16,318 patients, 3070 (18.8%) had anemia at baseline. All-cause death at 1 year (2.9% vs 1.5%), major bleeding (7.6% vs 3.6%, p <0.001), and transfusions (6.7% vs 1.5%, p <0.001) were more common in patients with baseline anemia. Spline transformations of the hazard for adverse events as a function of hemoglobin level on admission showed that adverse outcomes increased in a nonlinear fashion with lower levels of baseline hemoglobin; the lowest rates were observed at a level of ∼14 g/dl. Baseline hemoglobin and anemia were independent predictors of major bleeding and death. In conclusion, in patients with ACS, baseline hemoglobin carries important independent prognostic information and demonstrates a nonlinear association with major bleeding and mortality.
入院时贫血与急性冠脉综合征（ACS）患者不良结局之间的关联尚未得到充分研究。在两项针对ACS患者的大型试验中，贫血定义为女性血清血红蛋白<12 g/dl，男性血清血红蛋白<13 g/dl。我们根据基线血红蛋白绘制了30天时大出血以及1年时全因死亡率、心肌梗死和支架血栓形成的风险函数。在16318例患者中，3070例（18.8%）基线时存在贫血。基线贫血患者1年时的全因死亡（2.9%对1.5%）、大出血（7.6%对3.6%，p<0.001）和输血（6.7%对1.5%，p<0.001）更为常见。不良事件风险作为入院时血红蛋白水平的函数进行样条转换显示，不良结局随着基线血红蛋白水平降低呈非线性增加；在约14 g/dl水平时观察到最低发生率。基线血红蛋白和贫血是大出血和死亡的独立预测因素。总之，在ACS患者中，基线血红蛋白具有重要的独立预后信息，并与大出血和死亡率呈非线性关联。
