贫血对急性冠状动脉综合征患者预后的影响

Effects of anemia on the clinical outcomes in patients with acute coronary syndrome

目的:探讨贫血对急性冠状动脉(冠脉)综合征患者主要不良心血管事件的影响。方法:纳入行冠脉造影术的急性冠脉综合征患者428例,测定血红蛋白水平并进行临床随访;据血红蛋白水平分为贫血组和非贫血组,随访终点为心源性死亡、脑卒中、心力衰竭、非致死性心肌梗死以及因心绞痛再入院。建立Cox相对风险比例回归模型分析危险因素与终点事件间的关系,采用Kaplan-Meier法比较2组间生存率的差异。结果:贫血组的血红蛋白水平为107.5(81～120)g/L,非贫血组为136.0(111～178)g/L,平均随访期为20(1～120)个月,随访结束时共104例达终点。Cox回归模型显示血红蛋白(RR=0.363,95%CI:0.171～0.770,P=0.008)与急性冠脉综合征预后相关,Kaplan-Meier分析显示贫血组30d(92.0%∶96.9%,P=0.018)、90d(86.8%∶92.4%,P=0.048)及随访结束时(42.2%∶53.6%,P=0.035)的无事件累积生存率均低于非贫血组。结论:血红蛋白水平是影响急性冠脉综合征患者预后的因素之一,贫血的急性冠脉综合征患者预后较差。

Objective：To evaluate the effects of anemia on major adverse cardiac event（MACE） in patientswith acute coronary syndrome（ACS）. Method：Four hundred and twenty-eight patients with ACS who（delete） received coronary arteriography were enrolled in this study.Admission hemoglobin was obtained and patients were followed up.The patients were divided into 2 groups as anemia group and non-anemia group.Clinical end points were MACEs,including cardiogenic death,stroke,heart failure,nonfatal myocardial infarction,rehospitalisation for angina pectoris.Cox proportional hazard regression model was applied to analyze the relation between risk factors and end-point events,Kaplan-Meier analysis was used to compare the survival rates. Result：Mean hemoglobin was 107.5（81-120）g/L in anemia group and 136.0（111-178）g/L in non-anemia group.The average follow-up duration was 20（1-120） months and MACE occurred in 104 patients.The multivariable Cox proportional hazard regression model revealed that admission hemoglobin（RR=0.363,95%CI： 0.171-0.770,P=0.008） could indicate the prognosis of ACS in some way.Kaplan-Meier analysis of short-term and long-term survival showed that MACE-free cumulative survival rate in anemia group was lower than that in non-anemia group at 30 d point（92.0% vs 96.9%,P=0.018）,90 d point（86.8% vs 92.4%,P=0.048）,and through the follow up（42.2% vs 53.6%,P=0.035）. Conclusion：Hemoglobin level is an independent predictor for patients with ACS.ACS patients with anemia have a poorer prognosis than the counterparts without anemia.