Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan.
Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan.
J Am Heart Assoc. 2019 Nov 19;8(22):e013703. doi: 10.1161/JAHA.119.013703. Epub 2019 Nov 8.
Background Association of baseline hemoglobin levels with long-term adverse events after percutaneous coronary interventions has not been yet thoroughly defined. We aimed to assess the clinical impact of baseline hemoglobin on long-term ischemic and bleeding risk after percutaneous coronary intervention. Methods and Results Using the pooled individual patient-level data from the 3 percutaneous coronary intervention studies, we categorized 19 288 patients into 4 groups: high-normal hemoglobin (≥14.0 g/dL; n=7555), low-normal hemoglobin (13.0-13.9 g/dL in men and 12.0-13.9 g/dL in women; n=5303), mild anemia (11.0-12.9 g/dL in men and 11.0-11.9 g/dL in women; n=4117), and moderate/severe anemia (<11.0 g/dL; n=2313). Median follow-up duration was 3 years. Low-normal hemoglobin, mild anemia, and moderate/severe anemia correlated with significant excess risk relative to high-normal hemoglobin for GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Trial) moderate/severe bleeding, with adjusted hazard ratios of 1.22 (95% CI, 1.04-1.44), 1.73 (95% CI, 1.47-2.04), and 2.31 (95% CI, 1.92-2.78), respectively. Moderate/severe anemia also correlated with significant excess risk relative to high-normal hemoglobin for the ischemic composite end point of myocardial infarction/ischemic stroke (adjusted hazard ratio, 1.33; 95% CI, 1.11-1.60), whereas low-normal hemoglobin and mild anemia did not. However, the excess risk of low-normal hemoglobin, mild anemia, and moderate/severe anemia relative to high-normal hemoglobin remained significant for ischemic stroke and for mortality. Conclusions Decreasing baseline hemoglobin correlated with incrementally higher long-term risk for major bleeding, ischemic stroke, and mortality after percutaneous coronary intervention. Even within normal range, lower baseline hemoglobin level correlated with higher ischemic and bleeding risk.
背景 经皮冠状动脉介入治疗后，基线血红蛋白水平与长期不良事件的关系尚未得到充分明确。本研究旨在评估经皮冠状动脉介入治疗后基线血红蛋白水平对长期缺血和出血风险的临床影响。
方法 我们利用 3 项经皮冠状动脉介入治疗研究的个体患者水平汇总数据，将 19288 例患者分为 4 组：高正常血红蛋白组（≥14.0 g/dL；n=7555）、低正常血红蛋白组（男性 13.0-13.9 g/dL，女性 12.0-13.9 g/dL；n=5303）、轻度贫血组（男性 11.0-12.9 g/dL，女性 11.0-11.9 g/dL；n=4117）和中重度贫血组（<11.0 g/dL；n=2313）。中位随访时间为 3 年。与高正常血红蛋白相比，低正常血红蛋白、轻度贫血和中重度贫血与 GUSTO（全球应用链激酶和组织型纤溶酶原激活剂治疗闭塞动脉试验）中重度出血风险显著增加相关，校正后危险比分别为 1.22（95%CI，1.04-1.44）、1.73（95%CI，1.47-2.04）和 2.31（95%CI，1.92-2.78）。中重度贫血与缺血复合终点（心肌梗死/缺血性卒中）也与高正常血红蛋白相比具有显著的风险增加，校正后危险比为 1.33（95%CI，1.11-1.60），而低正常血红蛋白和轻度贫血则没有。然而，与高正常血红蛋白相比，低正常血红蛋白、轻度贫血和中重度贫血的风险仍显著增加，包括缺血性卒中和死亡率。
结论 基线血红蛋白降低与经皮冠状动脉介入治疗后主要出血、缺血性卒中和死亡率的长期风险增加相关。即使在正常范围内，较低的基线血红蛋白水平也与较高的缺血和出血风险相关。
