贫血患者行左主干血运重建术的结果：海湾左主干注册研究。

Outcomes of Left Main Revascularization in Patients with Anemia: Gulf Left Main Registry.

机构信息

Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.

Department of Internal Medicine, Baystate Medical Center, Boston, Massachusetts, USA.

出版信息

Cardiology. 2023;148(3):173-186. doi: 10.1159/000530305. Epub 2023 Mar 24.

DOI:10.1159/000530305

PMID:36966525

Abstract

INTRODUCTION

The aim of this study was to evaluate the effects of baseline anemia and anemia following revascularization on outcomes in patients with unprotected left main coronary artery (ULMCA) disease.

METHODS

This was a retrospective, multicenter, observational study conducted between January 2015 and December 2019. The data on patients with ULMCA who underwent revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were stratified by the hemoglobin level at baseline into anemic and non-anemic groups to compare in-hospital events. The pre-discharge hemoglobin following revascularization was categorized into very low (<80 g/L for men and women), low (≥80 and ≤119 g/L for women and ≤129 g/L for men), and normal (≥130 g/L for men and ≥120 g/L for women) to assess impact on follow-up outcomes.

RESULTS

A total of 2,138 patients were included, 796 (37.2%) of whom had anemia at baseline. A total of 319 developed anemia after revascularization and moved from being non-anemic at baseline to anemic at discharge. There was no difference in hospital major adverse cardiac and cerebrovascular event (MACCE) and mortality between CABG and PCI in anemic patients. At a median follow-up time of 20 months (interquartile range [IQR]: 27), patients with pre-discharge anemia who underwent PCI had a higher incidence of congestive heart failure (CHF) (p < 0.0001), and those who underwent CABG had significantly higher follow-up mortality (HR: 9.85 (95% CI: 2.53-38.43), p = 0.001).

CONCLUSION

In this Gulf LM study, baseline anemia had no impact upon in-hospital MACCE and total mortality following revascularization (PCI or CABG). However, pre-discharge anemia is associated with worse outcomes after ULMCA disease revascularization, with significantly higher all-cause mortality in patients who had CABG, and a higher incidence of CHF in PCI patients, at a median follow-up time of 20 months (IQR: 27).

摘要

简介

本研究旨在评估基线贫血和血运重建后贫血对无保护左主干冠状动脉（ULMCA）疾病患者结局的影响。

方法

这是一项回顾性、多中心、观察性研究，于 2015 年 1 月至 2019 年 12 月进行。根据基线时的血红蛋白水平，将接受经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）血运重建的 ULMCA 患者的数据分为贫血组和非贫血组，以比较住院期间的事件。将血运重建后出院前的血红蛋白分为极低（男性 <80g/L，女性 <80g/L）、低（≥80g/L 且 ≤119g/L，女性 ≤129g/L，男性 ≤129g/L）和正常（男性≥130g/L，女性≥120g/L），以评估对随访结果的影响。

结果

共纳入 2138 例患者，其中 796 例（37.2%）基线时存在贫血。共有 319 例患者在血运重建后发生贫血，并从基线时的非贫血转为出院时的贫血。在贫血患者中，CABG 与 PCI 之间在住院期间主要不良心脑血管事件（MACCE）和死亡率方面无差异。在中位随访时间 20 个月（IQR：27）时，行 PCI 的出院前贫血患者充血性心力衰竭（CHF）发生率较高（p <0.0001），而行 CABG 的患者随访死亡率显著升高（HR：9.85（95%CI：2.53-38.43），p=0.001）。