急性心肌梗死患者入院贫血与临床结局的相关性研究

Correlation study between admission anemia and clinical outcome in patients with acute myocardial infarction

目的:评估入院贫血对急性心肌梗死(acute myocardial infarction,AMI)患者住院期间治疗方式和临床结果的影响。方法:选取2016年1月至2018年12月,南充市中心医院心内科诊断为AMI的1028例住院患者,比较合并贫血和不伴贫血的AMI患者血管再通治疗的差异性;Logistic回归模型评估按贫血分层的住院不良事件的优势比;Kaplan-Meyer图评估随访期内生存率的差异;Cox回归模型计算贫血状态的全因死亡风险比。结果:AMI合并轻度贫血102例(9.9%)、合并中-重度贫血56例(5.5%);相较于不伴贫血的AMI患者,合并贫血的患者更少选择介入治疗(P<0.05);住院期间的出血、总死亡率、心源性休克、心力衰竭、严重心律失常和卒中的发生率明显升高(P<0.05);Logistic回归分析显示贫血与住院期间的不良心血管事件、出血和死亡等并发症相关(P<0.05)。Kaplan-Meier图显示合并贫血的患者生存率明显低于非贫血患者(P<0.05);Cox回归分析结果表明贫血状态的全因死亡风险比明显增加(P<0.05)。结论:入院贫血增加AMI患者住院期间的出血、不良心血管事件和死亡风险,且对AMI后的长期生存有不利影响。

Objective:To assess the impact of admission anemia on treatment modalities during hospitalization and clinical outcomes in patients with acute myocardial infarction(AMI).Methods:A total of 1028 inpatients diagnosed with AMI from January 2016 to December 2018 in the Department of Cardiology,Nanchong Central Hospital.Comparison of the differences of revascularization therapy in patients with AMI with anemia and without anemia.Logistic regression models were used to estimate odds ratios of in-hospital adverse events stratified by anemia.Kaplan-Meyer plots assess differences in survival during follow-up.Cox regression model to calculate hazard ratio for all-cause mortality in anemia status.Results:AMI with mild anemia in 102 patients(9.9%)and moderate-severe anemia in 56 patients(5.5%).Compared with AMI patients without anemia,patients with anemia were less likely to choose interventional therapy(P<0.05),the incidence rate of bleeding,total mortality,cardiogenic shock,heart failure,severe arrhythmia and stroke during hospitalization was significantly increased(P<0.05).Logistic regression analysis showed that anemia was independently associated with adverse cardiovascular events,bleeding and death during hospitalization(P<0.05).Kaplan-Meier plot showed that the survival rate of patients with anemia was significantly lower than that of patients without anemia(P<0.05).Cox regression analysis showed that the hazard ratio of all-cause mortality was significantly increased in anemia status(P<0.05).Conclusions:Admission anemia increases the risk of bleeding,adverse cardiovascular events,and death during hospitalization in patients with AMI,and adversely affects long-term survival after AMI.