Stähli Barbara E, Gebhard Cathérine, Gick Michael, Ferenc Miroslaw, Mashayekhi Kambis, Buettner Heinz Joachim, Neumann Franz-Josef, Toma Aurel
Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany.
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany.
Catheter Cardiovasc Interv. 2018 Feb 1;91(2):226-233. doi: 10.1002/ccd.27412. Epub 2017 Nov 11.
A single-centre, observational study was performed in order to investigate the relationship between anemia and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
Anemia has been identified as adverse predictor in patients with coronary artery disease undergoing coronary revascularization. Data on the impact of anemia on outcomes in patients undergoing PCI for CTO lesions are lacking.
A total of 1,964 patients undergoing CTO PCI were stratified according to the presence/absence of anemia (hemoglobin of <13 g/dl for men and <12 g/dl for women). The primary endpoint was all-cause mortality. Median follow-up was 2.6 (interquartile range 1.1-3.1) years.
Of the 1,964 patients, 297 (15.1%) had anemia. Anemic as compared to nonanemic patients had and an increased all-cause mortality (27.9% versus 9.1%, P < 0.001), and associations remained significant after multivariable adjustments (adjusted HR 2.26, 95% CI 1.71-2.98, P < 0.001). All-cause mortality decreased with increasing hemoglobin tertiles (T1: 18.6%, T2: 8.6%, T3: 8.2%, log rank P < 0.001). Procedural success was associated with reduced all-cause mortality both in anemic (21.8% versus 47.2%, adjusted HR 0.59, 95% CI 0.37-0.93, P = 0.02) and nonanemic patients (7.8% versus 16.3%, adjusted HR 0.64, 95% CI 0.42-0.98, P = 0.02, interaction P = 0.69).
Although anemia is associated with an increased all-cause mortality in patients undergoing CTO PCI, the survival benefit associated with successful CTO recanalization is maintained.
开展一项单中心观察性研究，以调查慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）后贫血与预后之间的关系。
贫血已被确定为接受冠状动脉血运重建的冠心病患者的不良预测因素。关于贫血对接受CTO病变PCI患者预后影响的数据尚缺乏。
根据是否存在贫血（男性血红蛋白<13 g/dl，女性血红蛋白<12 g/dl）对总共1964例接受CTO PCI的患者进行分层。主要终点是全因死亡率。中位随访时间为2.6（四分位间距1.1 - 3.1）年。
在1964例患者中，297例（15.1%）有贫血。与非贫血患者相比，贫血患者全因死亡率更高（27.9%对9.1%，P < 0.001），多变量调整后关联仍然显著（调整后HR 2.26，95%CI 1.71 - 2.98，P < 0.001）。全因死亡率随血红蛋白三分位数增加而降低（T1：18.6%，T2：8.6%，T3：8.2%，对数秩检验P < 0.001）。手术成功与贫血（21.8%对47.2%，调整后HR 0.59，95%CI 0.37 - 0.93，P = 0.02）和非贫血患者（7.8%对16.3%，调整后HR 0.64，95%CI 0.42 - 0.98，P = 0.02，交互作用P = 0.69）的全因死亡率降低均相关。
尽管贫血与接受CTO PCI患者的全因死亡率增加相关，但成功的CTO再通相关的生存获益得以维持。
