Menzely Tomer, Zukermann Robert, Shehadeh Faheem, Muhammad Rabia Shekh, Aronson Doron, Kapeliovich Michael, Kerner Arthur, Yalonetsky Sergey, Gepstein Lior, Nikolsky Eugenia
The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Rambam Maimonides Med J. 2020 Apr 29;11(2):e0011. doi: 10.5041/RMMJ.10397.
To assess the impact of different types of anemia and of concomitant non-cardiovascular chronic illnesses on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and baseline anemia admitted to the Intensive Cardiac Care Unit.
Based on the mean corpuscular volume, anemia was stratified into: microcytic (<80 fL), normocytic (≥80, <96 fL), and macrocytic (≥96 fL). Data on concomitant chronic non-cardiovascular illnesses including malignancies were carefully collected. Endpoints included in-hospital bleeding as well as all-cause mortality at long-term follow-up.
Of 1,390 patients with STEMI, 294 patients had baseline anemia (21.2%), in whom normocytic, microcytic, and macrocytic anemia was present in 77.2%, 17.0%, and 5.8% patients, respectively. In-hospital bleeding occurred in 25 (8.5%) of the study population without significant differences between the three groups. At a mean follow-up of 5.5±3.5 years, 104 patients (35.4%) had died. Mortality was the highest in patients with macrocytic anemia, followed by patients with normocytic anemia and microcytic anemia (58.8%, 37.0%, and 20.0%, respectively; P=0.009). Chronic non-cardiovascular condition was identified as an independent predictor of both in-hospital bleeding (odds ratio=2.57, P=0.01) and long-term mortality (hazard ratio [HR] 1.54, P=0.019). Performance of coronary angiography within index hospitalization was associated with lower long-term mortality (HR 0.38, P=0.001). Mean corpuscular volume did not predict either in-hospital bleeding or mortality.
Chronic non-cardiovascular illnesses are highly prevalent among patients with STEMI and baseline anemia, and are strongly associated with higher in-hospital bleeding and long-term mortality. Type of anemia is not related to prognosis post-STEMI.
评估不同类型贫血及合并的非心血管慢性疾病对入住重症心脏监护病房的ST段抬高型心肌梗死（STEMI）患者及基线贫血患者预后的影响。
根据平均红细胞体积，将贫血分为：小细胞性贫血（<80 fL）、正细胞性贫血（≥80，<96 fL）和大细胞性贫血（≥96 fL）。仔细收集包括恶性肿瘤在内的合并慢性非心血管疾病的数据。终点指标包括住院期间出血以及长期随访时的全因死亡率。
在1390例STEMI患者中，294例患者存在基线贫血（21.2%），其中正细胞性贫血、小细胞性贫血和大细胞性贫血分别占77.2%、17.0%和5.8%。研究人群中有25例（8.5%）发生住院期间出血，三组之间无显著差异。在平均随访5.5±3.5年时，104例患者（35.4%）死亡。大细胞性贫血患者的死亡率最高，其次是正细胞性贫血和小细胞性贫血患者（分别为58.8%、37.0%和20.0%；P=0.009）。慢性非心血管疾病被确定为住院期间出血（比值比=2.57，P=0.01）和长期死亡率（风险比[HR]1.54，P=0.019）的独立预测因素。在首次住院期间进行冠状动脉造影与较低的长期死亡率相关（HR 0.38，P=0.001）。平均红细胞体积不能预测住院期间出血或死亡率。
慢性非心血管疾病在STEMI和基线贫血患者中高度普遍，并且与较高的住院期间出血和长期死亡率密切相关。贫血类型与STEMI后的预后无关。
