Spadafora Luigi, Cacciatore Stefano, Galli Mattia, Collet Carlos, Betti Matteo, Sarto Gianmarco, Simeone Beatrice, Rocco Erica, D'Ascenzo Fabrizio, De Ferrari Gaetano Maria, De Filippo Ovidio, Sabouret Pierre, Colaiori Iginio, Carnevale Roberto, Valenti Valentina, Gaudio Carlo, Zimatore Francesca Romana, Frati Giacomo, Versaci Francesco, Sciarretta Sebastiano, Biondi Zoccai Giuseppe, Bernardi Marco
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy.
Department of Geriatrics, Orthopedics, and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy.
J Clin Med. 2025 Apr 17;14(8):2756. doi: 10.3390/jcm14082756.
: Anemia and renal impairment are key predictors of adverse outcomes in acute coronary syndromes (ACSs). The hemoglobin-to-creatinine (Hb/Cr) ratio combines these parameters into a simple index. This study aimed to evaluate its prognostic value at discharge in patients with ST-elevation myocardial infarction (STEMI). : The primary endpoint was one-year all-cause mortality; secondary endpoints included major bleeding and the composite of all-cause mortality or reinfarction. Optimal Hb/Cr cut-off values were identified using Liu's method. Multivariable logistic regression and propensity score matching were used to assess associations with outcomes. : We analyzed 11,236 STEMI patients from the PRAISE registry with available hemoglobin and creatinine values at discharge. The optimal cut-points were 13.68 for mortality and 14.42 for secondary endpoints. Patients were stratified into low (<13.68; 26.5%) and high (≥13.68; 73.5%) Hb/Cr groups. The low Hb/Cr group was older, had more comorbidities, and received less intensive therapy. At one year, low Hb/Cr patients had significantly higher rates of all-cause mortality (8.7% vs. 2.4%), major bleeding (5.0% vs. 2.4%), and the composite outcome (11.5% vs. 4.9%). In the multivariate logistic regression, the Hb/Cr ratio was inversely associated with all outcomes, namely all-cause mortality (odds ratio [OR] 0.94; 95% confidence interval [CI]: 0.92-0.96), major bleeding (OR 0.96; 95% CI: 0.94-0.97), and the composite endpoint (OR 0.93; 95% CI: 0.91-0.96). The Hb/Cr ratio outperformed hemoglobin and creatinine alone in predicting mortality (AUC 0.684 vs. 0.649 and 0.645; < 0.001). : The Hb/Cr ratio is independently associated with one-year adverse outcomes in STEMI and may serve as a simple marker of increased vulnerability. Prospective studies are needed to validate its clinical utility.
贫血和肾功能损害是急性冠状动脉综合征（ACS）不良预后的关键预测因素。血红蛋白与肌酐（Hb/Cr）比值将这些参数整合为一个简单的指标。本研究旨在评估其对ST段抬高型心肌梗死（STEMI）患者出院时的预后价值。
主要终点为一年全因死亡率；次要终点包括大出血以及全因死亡率或再梗死的复合终点。使用刘法确定最佳Hb/Cr临界值。采用多变量逻辑回归和倾向得分匹配来评估与结局的关联。
我们分析了PRAISE注册研究中的11236例STEMI患者，这些患者出院时具有可用的血红蛋白和肌酐值。死亡率的最佳切点为13.68，次要终点的最佳切点为14.42。患者被分为低Hb/Cr组（<13.68；26.5%）和高Hb/Cr组（≥13.68；73.5%）。低Hb/Cr组患者年龄更大，合并症更多，接受的强化治疗更少。一年时，低Hb/Cr患者的全因死亡率（8.7%对2.4%）、大出血（5.0%对2.4%）和复合结局（11.5%对4.9%）发生率显著更高。在多变量逻辑回归中，Hb/Cr比值与所有结局均呈负相关，即全因死亡率（比值比[OR]0.94；95%置信区间[CI]：0.92 - 0.96）、大出血（OR 0.96；95% CI：0.94 - 0.97）和复合终点（OR 0.93；95% CI：0.91 - 0.96）。在预测死亡率方面，Hb/Cr比值优于单独的血红蛋白和肌酐（AUC分别为0.684对0.649和0.645；P < 0.001）。
Hb/Cr比值与STEMI患者一年不良结局独立相关，可作为易损性增加的一个简单标志物。需要前瞻性研究来验证其临床效用。
