贫血对接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者远期预后的影响

目的 探讨贫血对接受经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者远期预后的影响.方法在我院接受单纯PCI治疗并且术前有血红蛋白记录的ACS患者3136例,根据WHO关于贫血的诊断标准(女性<120 g/L,男性<130 g/L),诊断为贫血636例,无贫血2500例.比较贫血和无贫血患者的临床特点、术后病死率和主要心脑血管不良事件(MACCE,包括非致死性急性心肌梗死、再次血运重建和非致死性脑卒中)发生情况.平均随访550 d.结果贫血组患者年龄较大,女性、糖尿病、高血压、脑血管病史、慢性肾功能不全病史、ST段和非ST段抬高心肌梗死的比例较高,肌酐水平偏高,低密度脂蛋白胆固醇和甘油三酯较低,三支病变的比例明显高于无贫血组(31.9%比21.6%,P<0.001),而且完全血管重建率低(69.3%比73.8%,P:0.025).贫血组患者术后病死率(4.7%比1.5%,P<0.001)和MACCE发生率(14.2%比11.0%,P=0.032)均明显高于无贫血组.多因素Cox回归分析,校正其他因素后,ACS患者PCI术前贫血是影响病死率的独立预测因素(RR2.166,95%C/1.298～3.612,P=0.003),而时MACCE事件无显著影响.结论PCI术前贫血是ACS患者远期病死率的独立预测因素.

Effect of anemia on long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Objective To assess the effect of anemia on long-term outcomes in patients with acute coronary syndrome(ACS) undergoing pereutaneous coronary intervention(PCI). Methods In 3136 patients presenting with ACS,636 patients were anemic. The clinical features, mortality and major cardiocerebral events including non-fatal acute myocardial infaret,revascularization and non-fatal cerebral stroke were compared in patients with or without anemia. The average follow-up period was 550 days. Results Anemic patients were older and had a higher percentage of comorbidities compared with nonanemic cohorts. Compared with nonanemic patients, anemic patients had higher mortality (4.7% versus 1.5% ,P <0. 001) and a higher major adverse end point events,including nonfatalmyocardial infarction, stroke and revaseularization (14.2% versus 11.0%, P = 0.032). After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention (adjusted hazard rate ratioRR2. 166 ;95% CI 1. 298-3. 612 ;P =0.003). Conclusion Anemia before PCI is an independent factor for predicting the long-term mortality of ACS.