Pei Junyu, Wang Xiaopu, Chen Pengfei, Zheng Keyang, Hu Xinqun
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Jul 16;8:653351. doi: 10.3389/fcvm.2021.653351. eCollection 2021.
Women had worse outcomes after acute myocardial infarction (AMI), and physiologically, women had lower hemoglobin values. We examined whether there were sex-related differences in the relationship between hemoglobin levels and adverse outcomes in patients with acute myocardial infarction. We conducted a analysis of data from the Acute Coronary Syndrome Quality Improvement in Kerala (ACS-QUIK) Study. We explored the relationship between baseline hemoglobin level and 30-days adverse outcomes by logistic regression model, generalized additive model (GAM) and two-piecewise linear regression model. We used multiple imputation, based on five replications and a chained equation approach method in the R multiple imputation procedure, to account for missing data. The primary outcome were 30-day major adverse cardiovascular events (MACEs) defined as death, reinfarction, stroke, and major bleeding. The secondary outcomes were 30-day major bleeding, 30-day stroke and 30-day cardiovascular death (CVD death). Twenty thousand, five hundred fifty-nine patients with AMI were included in our analysis. Baseline hemoglobin level was associated with major bleeding [OR: 0.74, 95%CI (0.60, 0.92) < 0.01], CVD death [OR: 0.94, 95%CI (0.90, 0.99) < 0.01], and MACEs [OR: 0.95, 95%CI (0.92, 0.99) < 0.01]. There was no significant relationship between baseline hemoglobin level and stroke incidence in both men [OR: 1.02, 95%CI (0.90, 1.14) = 0.77] and women [OR: 1.15, 95%CI (0.96, 1.37) = 0.18]. Baseline hemoglobin level was associated with major bleeding [OR: 0.71, 95%CI (0.58, 0.85) < 0.01] in male patients, however we did not find the same relationship in female patients [OR: 0.89, 95%CI (0.56, 1.41) = 0.61]. GAM and two-piecewise linear regression model showed the relationships of hemoglobin level with major bleeding, CVD death, and MACEs were non-linear (non-linear < 0.05), and the threshold value were 13, 14.8, and 14.3 g/dL for MACEs and CVD death, respectively. Baseline hemoglobin level was one of the independent predictors of prognosis in South Asia patients with acute myocardial infarction. Moreover, its impact on prognosis was largely different depending on the patients' sex.
急性心肌梗死（AMI）后女性的预后较差，而且从生理角度来看，女性的血红蛋白值较低。我们研究了急性心肌梗死患者血红蛋白水平与不良预后之间的关系是否存在性别差异。我们对喀拉拉邦急性冠状动脉综合征质量改善研究（ACS-QUIK）的数据进行了分析。我们通过逻辑回归模型、广义相加模型（GAM）和两段式线性回归模型探讨了基线血红蛋白水平与30天不良预后之间的关系。我们使用多重填补法，基于R多重填补程序中的五次重复和链式方程方法来处理缺失数据。主要结局是30天主要不良心血管事件（MACE），定义为死亡、再梗死、中风和大出血。次要结局是30天大出血、30天中风和30天心血管死亡（CVD死亡）。我们的分析纳入了20559例AMI患者。基线血红蛋白水平与大出血相关[比值比（OR）：0.74，95%置信区间（CI）（0.60，0.92），P<0.01]、CVD死亡相关[OR：0.94，95%CI（0.90，0.99），P<0.01]以及MACE相关[OR：0.95，95%CI（0.92，0.99），P<0.01]。在男性[OR：1.02，95%CI（0.90，1.14），P = 0.77]和女性[OR：1.15，95%CI（0.96，1.37），P = 0.18]中，基线血红蛋白水平与中风发生率均无显著关系。基线血红蛋白水平与男性患者的大出血相关[OR：0.71，95%CI（0.58，0.85），P<0.01]，然而在女性患者中我们未发现相同关系[OR：0.89，95%CI（0.56，1.41），P = 0.61]。GAM和两段式线性回归模型显示，血红蛋白水平与大出血、CVD死亡和MACE的关系是非线性的（非线性，P<0.05），MACE和CVD死亡的阈值分别为13、14.8和14.3 g/dL。基线血红蛋白水平是南亚急性心肌梗死患者预后的独立预测因素之一。此外，其对预后的影响在很大程度上因患者性别而异。
