接受Impella支持的PCI患者贫血的影响：来自PROTECT III研究的见解。
Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study.
作者信息
Falah Batla, Redfors Björn, Zhao Duzhi, Bharadwaj Aditya S, Basir Mir Babar, Thompson Julia B, Patel Rajan A G, Schonning Michael J, Abu-Much Arsalan, Zhang Yiran, Batchelor Wayne B, Grines Cindy L, O'Neill William W
机构信息
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States.
Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States.
出版信息
Front Cardiovasc Med. 2024 Jul 18;11:1429900. doi: 10.3389/fcvm.2024.1429900. eCollection 2024.
BACKGROUND
Anemia is prevalent among patients with cardiovascular disease and is associated with adverse outcomes. However, data regarding the impact of anemia in high-risk percutaneous coronary intervention (HRPCI) are limited.
OBJECTIVES
This study aimed to evaluate the impact of anemia in patients undergoing Impella-supported HRPCI in the PROTECT III study.
METHODS
Patients undergoing Impella-supported HRPCI in the multicenter PROTECT III study were assessed for anemia based on baseline hemoglobin levels according to World Health Organization criteria. Patients were stratified into three groups, namely, no anemia, mild anemia, and moderate or severe anemia. Major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days, and major bleeding events were compared across groups.
RESULTS
Of 1,071 patients with baseline hemoglobin data, 37.9% had no anemia, 43.4% had mild anemia, and 18.7% had moderate or severe anemia. Anemic patients were older and more likely to have comorbidities. Anemia was associated with higher MACCE rates at 30 days (moderate to severe, 12.3%; mild, 9.8%; no anemia, 5.4%; = 0.02) and at 90 days (moderate to severe, 18.7%; mild, 14.6%; none, 8.3%; = 0.004). These differences persisted after adjustment for potential confounders at 30 and 90 days, and sensitivity analysis excluding dialysis showed similar results. Major bleeding at 30 days was also higher in anemic patients (5.5% vs. 1.2%, = 0.002).
CONCLUSION
Baseline anemia in Impella-supported HRPCI is common and independently associated with MACCE and major bleeding, emphasizing its significance as a prognostic factor Specific management strategies to reduce anemia-associated MACCE risk after HRPCI should be examined. Trial Name: The Global cVAD Study (cVAD)ClinicalTrial.gov Identifier: NCT04136392URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2.
背景
贫血在心血管疾病患者中普遍存在，且与不良预后相关。然而，关于贫血对高危经皮冠状动脉介入治疗（HRPCI）影响的数据有限。
目的
本研究旨在评估在PROTECT III研究中接受Impella支持的HRPCI患者贫血的影响。
方法
在多中心PROTECT III研究中，根据世界卫生组织标准，基于基线血红蛋白水平对接受Impella支持的HRPCI患者进行贫血评估。患者被分为三组，即无贫血、轻度贫血和中度或重度贫血。比较三组在30天和90天时的主要不良心血管和脑血管事件（MACCE：全因死亡、心肌梗死、中风/短暂性脑缺血发作和再次血运重建）以及主要出血事件。
结果
在1071例有基线血红蛋白数据的患者中，37.9%无贫血，43.4%有轻度贫血，18.7%有中度或重度贫血。贫血患者年龄较大，更易合并其他疾病。贫血与30天时较高的MACCE发生率相关（中度至重度，12.3%；轻度，9.8%；无贫血，5.4%；P = 0.02）以及90天时较高的MACCE发生率相关（中度至重度，18.7%；轻度，14.6%；无贫血，8.3%；P = 0.004）。在对30天和90天的潜在混杂因素进行调整后，这些差异仍然存在，排除透析的敏感性分析显示了相似的结果。贫血患者30天时的主要出血发生率也更高（5.5%对1.2%，P = 0.002）。
结论
在接受Impella支持的HRPCI中，基线贫血很常见，且与MACCE和主要出血独立相关，强调了其作为预后因素的重要性。应研究降低HRPCI后贫血相关MACCE风险的具体管理策略。试验名称：全球cVAD研究（cVAD）。ClinicalTrial.gov标识符：NCT04136392。网址：https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2 。
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