贫血对经皮冠状动脉介入治疗远期预后的影响

Anemia as an independent predictor of poor long-term outcomes after percutaneous coronary intervention

目的了解贫血对接受经皮冠状动脉（冠脉）介入治疗（PCI）冠心病患者远期预后的影响。方法2003年7月至2005年9月接受单纯PCI治疗冠心病患者3809例，诊断为贫血患者744例，无贫血患者3065例。比较两组患者的临床特点、术后病死率和主要心脑血管不良事件（MACCE）的发生情况。平均随访548d。结果贫血患者除具有年龄较大，女性、糖尿病、脑血管病史、慢性肾功能不全病史、急性冠脉综合征比例、肌酐水平偏高以及左室射血分数较低的特点外，冠脉3支病变的比例明显高于无贫血患者（30．9％比21．5％，P〈0．001），而且完全血管重建率低（70．0％比73．9％，P=0．034），术后病死率（4．7％比1．5％，P〈0．001）和MACCE发生率（14．0％比10．8％，P=0．014）均明显增高。多因素Cox回归分析显示，PCI术前贫血是影响病死率的独立预测因素，而对MACCE事件无显著影响。结论PCI术前贫血是影响病死率的独立预测因素。

Objective To assess whether anemia is an independent predictor of poor long-term outcome after percutaneous coronary intervention（PCI）. Methods The second drug-during stent impact on revascularization registry （DESIRE-2） is a single-center registry of 6005 patients undergoing coronary revascularization from July 2003 to September. 2005. We examined the clinical data and outcome of 3809 PCI patients based on hemoglobin （Hb） value before the interventional procedure. Patients were classified as anemia using the World Health Organization definition （ 〈 120 g/L in women and 〈 130 g/L in men）. 744 of the 3809 patients were anemic. We compared the clinical features and prognosis of the patients with or without anemia. Results Anemic patients were older and had a higher percentage of comorbidities as compared with the nonanemic ones. When compared with nonanemic patients, anemic patients had higher mortality （4. 7% vs 1.5%, P 〈 0. 001 ） and higher major adverse event end points, including nonfatal myocardial infarction, stroke and revascularization （ 14. 0% vs 10. 8%, P = 0. 014）. After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention （RR 2. 216, 95% CI 1. 019-4. 428 ; P = 0. 024）. Conclusions Anemia is an independent predictor of mortality after PCI. Since PCI is a common procedure and anemia is a frequent condition in the general population, strategies for the management of anemic PCI patients should be developed.