Zhou He, Qiu Miaohan, Guan Shaoyi, Liang Zhenyang, Li Yi, Han Yaling
State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, China.
Sci Rep. 2025 Apr 14;15(1):12773. doi: 10.1038/s41598-025-97762-1.
Whether an in-hospital hemoglobin drop adversely affects the prognosis of patients with acute myocardial infarction (AMI) remains controversial. The present study aimed to investigate the impacts of in-hospital hemoglobin drop without overt bleeding on 1-year clinical outcomes of AMI patients after percutaneous coronary intervention (PCI). A total of 5,036 AMI patients who underwent PCI and presented with an in-hospital hemoglobin decline without overt bleeding were recruited in this study. Subsequently, these patients were stratified into three cohorts based on tertiles of hemoglobin drop values: < 0.8 g/dL (n = 1652), 0.8-1.49 g/dL (n = 1651) and ≥ 1.5 g/dL (n = 1733). The primary endpoint was defined as ischemic events at 1 year, composed of cardiac death, myocardial infarction (MI), and stroke. Secondary endpoints were defined as 1-year all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding. There were significant differences in 1-year incidence of ischemic events (1.88% vs. 3.27% vs. 3.46%; P = 0.0114), all-cause death (1.45% vs. 2.18% vs. 2.94%; P = 0.0128), as well as cardiac death (1.15% vs. 1.82% vs. 2.37%; P = 0.0282) and MI (0.30% vs. 1.15% vs. 0.92%; P = 0.0175) across tertiles of hemoglobin drop values. For each 1 g/dL drop in hemoglobin values, the adjusted risk for ischemic events and all-cause death increased by 2% and 3%, respectively. Among AMI patients undergoing PCI, an in-hospital decline in hemoglobin levels was associated with an increased risk of 1-year ischemic events and all-cause death, even in the absence of overt bleeding.
住院期间血红蛋白下降是否会对急性心肌梗死（AMI）患者的预后产生不利影响仍存在争议。本研究旨在调查无明显出血情况下住院期间血红蛋白下降对接受经皮冠状动脉介入治疗（PCI）的AMI患者1年临床结局的影响。本研究共纳入5036例接受PCI且住院期间血红蛋白下降且无明显出血的AMI患者。随后，根据血红蛋白下降值的三分位数将这些患者分为三组：<0.8 g/dL（n = 1652）、0.8 - 1.49 g/dL（n = 1651）和≥1.5 g/dL（n = 1733）。主要终点定义为1年时的缺血事件，包括心源性死亡、心肌梗死（MI）和中风。次要终点定义为1年全因死亡、出血学术研究联盟（BARC）2、3或5型出血以及3或5型出血。血红蛋白下降值三分位数组间在1年缺血事件发生率（1.88% vs. 3.27% vs. 3.46%；P = 0.0114）、全因死亡（1.45% vs. 2.18% vs. 2.94%；P = 0.0128）、心源性死亡（1.15% vs. 1.82% vs. 2.37%；P = 0.0282）和MI（0.30% vs. 1.15% vs. 0.92%；P = 0.0175）方面存在显著差异。血红蛋白值每下降1 g/dL，缺血事件和全因死亡调整后的风险分别增加2%和3%。在接受PCI的AMI患者中，即使没有明显出血，住院期间血红蛋白水平下降也与1年缺血事件和全因死亡风险增加相关。
