Masini Gabriele, Barsacchi Matilde, Chiusolo Simona, Alberti Mattia, Gargani Luna, Corradi Francesco, De Caterina Raffaele
Chair and Postgraduate School of Cardiology, University of Pisa and Cardiovascular Division 1, Pisa University Hospital, Pisa, Italy.
Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Am J Med. 2025 Jul;138(7):1099-1105.e6. doi: 10.1016/j.amjmed.2025.03.003. Epub 2025 Mar 20.
Iron deficiency is common in heart failure and relates to a worse prognosis, but its role in acute coronary syndromes is unclear. This study assessed iron deficiency prevalence, correlation with infarct size and left ventricular function, and association with in-hospital and post-discharge events in such patients.
We analyzed 152 acute coronary syndrome patients using multiple iron deficiency definitions: serum iron <6 µmol/L or <13 µmol/L; transferrin saturation (TSAT) <20%; ferritin <100 µg/L; and a combined definition - ferritin <100 µg/L or TSAT<20% if ferritin 100-299 µg/L. Infarct size was approximated by peak cardiac troponin T. Cox regression analysis examined associations with in-hospital complications (death, sustained arrhythmias, or Killip class ≥3) and post-discharge events (death, myocardial infarction, or stroke).
The prevalence of iron deficiency ranged from 21% to 62%, depending on definitions. Patients with deficiency defined by serum iron or TSAT were older, more frequently female, with more cardiovascular risk factors, and higher high-sensitivity C-reactive protein. Serum iron <13 µmol/L and TSAT <20% correlated with lower left ventricular ejection fraction but not with greater infarct size. Iron deficiency did not predict in-hospital complications, whereas serum iron <6 µmol/L was associated with a higher risk of post-discharge events. Such association lost significance after adjustment for hs-CRP. Lower ferritin predicted fewer events.
Iron deficiency is frequent in acute coronary syndromes. Definitions by serum iron and TSAT identify patients with worse left ventricular systolic function and more inflammation, potentially influencing prognosis.
缺铁在心力衰竭中很常见，且与预后较差有关，但其在急性冠状动脉综合征中的作用尚不清楚。本研究评估了此类患者中铁缺乏的患病率、与梗死面积和左心室功能的相关性，以及与住院期间和出院后事件的关联。
我们使用多种缺铁定义分析了152例急性冠状动脉综合征患者：血清铁<6 μmol/L或<13 μmol/L；转铁蛋白饱和度（TSAT）<20%；铁蛋白<100 μg/L；以及一个联合定义——如果铁蛋白为100 - 299 μg/L，则铁蛋白<100 μg/L或TSAT<20%。梗死面积通过心肌肌钙蛋白T峰值进行估算。Cox回归分析检查了与住院并发症（死亡、持续性心律失常或Killip分级≥3）和出院后事件（死亡、心肌梗死或中风）的关联。
根据定义，缺铁的患病率在21%至62%之间。由血清铁或TSAT定义为缺铁的患者年龄更大，女性更常见，有更多心血管危险因素，且高敏C反应蛋白更高。血清铁<13 μmol/L和TSAT<20%与较低的左心室射血分数相关，但与较大的梗死面积无关。缺铁不能预测住院并发症，而血清铁<6 μmol/L与出院后事件的较高风险相关。在调整高敏C反应蛋白后，这种关联失去了显著性。较低的铁蛋白预示着事件较少。
急性冠状动脉综合征中铁缺乏很常见。血清铁和TSAT定义可识别出左心室收缩功能较差且炎症更多的患者，这可能影响预后。
