Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku, Tokyo, 162-8666, Japan.
Heart Vessels. 2021 Nov;36(11):1626-1634. doi: 10.1007/s00380-021-01850-x. Epub 2021 Apr 11.
Despite a clear correlation between anemia and mortality in patients with the acute coronary syndrome (ACS), anemia as a mortality predictor in patients with ACS-receiving early invasive strategy and contemporary lipid-lowering therapy has not been examined. Therefore, we aimed to evaluate the association between anemia and mortality in ACS patients treated with acute revascularization and contemporary lipid-lowering treatment. This was a post-hoc study of the Heart Institute of Japan-Proper level of Lipid-Lowering with Pitavastatin and Ezetimibe in acute coronary syndrome study, in which ACS patients with dyslipidemia were randomized to receive either pitavastatin and ezetimibe or pitavastatin monotherapy. The success rate of primary percutaneous coronary intervention (PCI) was 95.2%. Eligible patients were divided into two groups: patients with anemia (anemia group) or without anemia (non-anemia group). Anemia was defined using the World Health Organization definition hemoglobin < 12 g/dL for women and < 13 g/dL for men. We compared the mortality between the two groups using propensity scores derived from 17 baseline variables. We identified 1721 eligible patients, including 420 (24.4%) in the anemia group and 1301 (75.6%) in the non-anemia group. One-to-one propensity score-matching created 381 pairs. Both unmatched and matched analyses found significantly high mortality in the anemia group compared to the non-anemia group (unmatched 12.3% vs. 3.8%, log-rank p < 0.01; matched 11.5% vs. 6.3%, log-rank p = 0.01). In ACS patients treated with an early invasive strategy era with a high PCI success rate and concurrent contemporary lipid-lowering management, all-cause mortality was still significantly higher in anemic patients than in non-anemic patients.Trial registration: Clinical trial registration URL: http://www.umin.ac.jp/ctr . Unique identifier: UMIN00000274.
尽管急性冠状动脉综合征 (ACS) 患者的贫血与死亡率之间存在明显相关性，但在接受早期侵入性策略和当代降脂治疗的 ACS 患者中，贫血作为死亡率预测因子尚未得到检验。因此，我们旨在评估在接受急性血运重建和当代降脂治疗的 ACS 患者中贫血与死亡率之间的关联。这是日本心脏病研究所 - 匹伐他汀和依折麦布适当降脂水平治疗急性冠状动脉综合征研究的事后研究，其中将血脂异常的 ACS 患者随机分为接受匹伐他汀和依折麦布或匹伐他汀单药治疗。经皮冠状动脉介入治疗（PCI）的成功率为 95.2%。符合条件的患者被分为两组：贫血组（贫血组）和非贫血组（非贫血组）。贫血采用世界卫生组织的定义，即女性血红蛋白<12 g/dL，男性血红蛋白<13 g/dL。我们使用来自 17 个基线变量的倾向得分比较了两组之间的死亡率。我们确定了 1721 名符合条件的患者，其中贫血组 420 例（24.4%），非贫血组 1301 例（75.6%）。采用一对一倾向得分匹配创建了 381 对。未匹配和匹配分析均发现贫血组的死亡率明显高于非贫血组（未匹配 12.3%比 3.8%，对数秩 p<0.01；匹配 11.5%比 6.3%，对数秩 p=0.01）。在 ACS 患者接受早期侵入性策略时代，PCI 成功率高，同时进行当代降脂治疗，贫血患者的全因死亡率仍明显高于非贫血患者。试验注册：临床试验注册网址：http://www.umin.ac.jp/ctr. 独特标识符：UMIN00000274。
