Velásquez-Rodríguez Jesús, Diez-Delhoyo Felipe, Valero-Masa María Jesús, Vicent Lourdes, Devesa Carolina, Sousa-Casasnovas Iago, Juárez Miriam, Angulo-Llanos Rocío, Fernández-Avilés Francisco, Martínez-Sellés Manuel
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain.
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense Madrid, Madrid, Spain.
Am J Cardiol. 2017 Jun 15;119(12):1909-1916. doi: 10.1016/j.amjcard.2017.03.018. Epub 2017 Mar 29.
Advanced age and low hemoglobin levels have been associated with a poor prognosis in ST-segment elevation myocardial infarction (STEMI). We studied 1,111 patients with STEMI who received reperfusion treatment (1,032 [92.9%] primary angioplasty and 79 [7.1%] fibrinolysis without rescue percutaneous coronary intervention). Mean age was 64.1 ± 14.0 years, and 23.2% were women. Patients in the last age quartile (>76 years) were more frequently women, presented more risk factors (except smoking), received thrombolysis less frequently, had less complete revascularization, and presented more complications and higher mortality. Hemoglobin level at admission was associated with age and ranged from 14.8 ± 1.5 g/dl in the first quartile to 13.2 ± 1.8 g/dl in the last, p <0.001. Multivariate analysis identified age as a predictor of in-hospital and long-term mortality (odds ratio 1.04, 95% confidence interval [CI] 1.00 to 1.07, hazard ratio 1.06, 95% CI 1.04 to 1.08). Hemoglobin levels were associated with better survival (odds ratio 0.8, 95% CI 0.6 to 0.9, hazard ratio 0.85, 95% CI 0.78 to 0.92). The other predictors of inhospital mortality were Killip class, chronic kidney disease, left ventricular ejection fraction, significant pericardial effusion, and ventricular arrhythmias. The association of hemoglobin with hospital mortality was seen in men and in women ≥65 years. In men ≥65 years, this association was also present in those with hemoglobin levels in the normal range. In conclusion, in patients with STEMI, hemoglobin is an independent predictor of inhospital and long-term mortality, especially in those aged ≥65 years. This association is also present in men ≥65 years with normal hemoglobin levels.
高龄和低血红蛋白水平与ST段抬高型心肌梗死（STEMI）的预后不良相关。我们研究了1111例接受再灌注治疗的STEMI患者（1032例[92.9%]接受直接血管成形术，79例[7.1%]接受溶栓治疗且未进行补救性经皮冠状动脉介入治疗）。平均年龄为64.1±14.0岁，女性占23.2%。年龄处于最高四分位数（>76岁）的患者中女性更为常见，存在更多危险因素（吸烟除外），接受溶栓治疗的频率更低，血管再通不完全的情况更多，出现的并发症更多且死亡率更高。入院时的血红蛋白水平与年龄相关，范围从第一个四分位数的14.8±1.5 g/dl到最后一个四分位数的13.2±1.8 g/dl，p<0.001。多变量分析确定年龄是住院和长期死亡率的预测因素（比值比1.04，95%置信区间[CI]1.00至1.07，风险比1.06，95%CI 1.04至1.08）。血红蛋白水平与更好的生存率相关（比值比0.8，95%CI 0.6至0.9，风险比0.85，95%CI 0.78至0.92）。住院死亡率的其他预测因素包括Killip分级、慢性肾病、左心室射血分数、大量心包积液和室性心律失常。血红蛋白与住院死亡率的关联在男性和65岁及以上的女性中均可见。在65岁及以上的男性中，这种关联在血红蛋白水平处于正常范围的人群中也存在。总之，在STEMI患者中，血红蛋白是住院和长期死亡率的独立预测因素，尤其是在65岁及以上的患者中。这种关联在血红蛋白水平正常的65岁及以上男性中也存在。
