Wang Shan, Zhang You, Qi Datun, Wang Xianpei, Zhu Zhongyu, Yang Wei, Li Muwei, Hu Dayi, Gao Chuanyu
Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China.
Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China.
Int J Cardiol Heart Vasc. 2024 Mar 2;51:101377. doi: 10.1016/j.ijcha.2024.101377. eCollection 2024 Apr.
The higher prevalence of anemia in females and elderly may be attributed to its association with worsened outcomes in ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the precise effects of age and gender on the association between anemia and 30-day outcomes.
We identified 4350 STEMI patients and divided into anemia and non-anemia. Effects were analyzed as categories using Cox proportional-hazards regression and as continuous using restricted cubic splines. Propensity score matching (PSM) and mediation analysis were applied to identify intermediate effects.
Anemic patients were older, more likely to be female, and experienced doubled all-cause death (7.3 % versus 15.0 %), main adverse cardiovascular and cerebrovascular events (MACCE, 11.1 % versus 20.2 %), heart failure (HF, 5.1 % versus 8.6 %), and bleeding events (2.7 % versus 5.4 %). After adjustment, the association between anemia and all-cause death (Hazard ratio (HR) 1.15, 95 % confidence interval (95 %CI) 0.93-1.14), MACCE (HR 1.14, 95 %CI 0.95-1.36) and HF (HR 1.19, 95 %CI 0.92-1.55) were insignificant, the effects persisted nullified across age classes (P-interaction > 0.05) and PSM (P > 0.05). Ulteriorly, age mediated 77.6 %, 66.2 %, 48.0 %, gender mediated 38.1 %, 15.0 %, 3.2 %, age and gender together mediated 99.8 % 72.9 %, 48.1 % of the relationship. Anemia was independently associated with bleeding events (HR 2.02, 95 %CI 1.42-2.88), the effects consisted significant regardless of PSM (P < 0.05), age, and gender classes (P > 0.05), and no mediating role of age and gender were observed.
In STEMI patients, age and gender largely mediated the relationship between anemia and all-cause death, MACCE, and HF, anemia was independently associated with bleeding complications.
女性和老年人贫血患病率较高，这可能与其与ST段抬高型心肌梗死（STEMI）患者预后恶化有关。我们旨在评估年龄和性别对贫血与30天预后之间关联的精确影响。
我们纳入了4350例STEMI患者，并将其分为贫血组和非贫血组。使用Cox比例风险回归分析效应类别，并使用受限立方样条分析效应的连续性。应用倾向评分匹配（PSM）和中介分析来确定中间效应。
贫血患者年龄更大，更可能为女性，全因死亡（7.3%对15.0%）、主要心血管和脑血管不良事件（MACCE，11.1%对20.2%）、心力衰竭（HF，5.1%对8.6%）和出血事件（2.7%对5.4%）的发生率翻倍。调整后，贫血与全因死亡（风险比（HR）1.15，95%置信区间（95%CI）0.93 - 1.14）、MACCE（HR 1.14，95%CI 0.95 - 1.36）和HF（HR 1.19，95%CI 0.92 - 1.55）之间的关联不显著，在各年龄组（P交互作用>0.05）和PSM（P>0.05）中效应持续消失。此外，年龄介导了77.6%、66.2%、48.0%，性别介导了38.1%、15.0%、3.2%，年龄和性别共同介导了99.8%、72.9%、48.1%的关系。贫血与出血事件独立相关（HR 2.02，95%CI 1.42 - 2.88），无论PSM（P<0.05）、年龄和性别类别（P>0.05）如何，效应均显著，且未观察到年龄和性别的中介作用。
在STEMI患者中，年龄和性别在很大程度上介导了贫血与全因死亡、MACCE和HF之间的关系，贫血与出血并发症独立相关。
