Impact of Admission Anemia on Coronary Microcirculation and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
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- Uchida Yasuhiro
- Department of Cardiology, Yokkaichi Municipal Hospital
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- Ichimiya Satoshi
- Department of Cardiology, Yokkaichi Municipal Hospital
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- Ishii Hideki
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Kanashiro Masaaki
- Department of Cardiology, Yokkaichi Municipal Hospital
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- Watanabe Junji
- Department of Cardiology, Yokkaichi Municipal Hospital
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- Hayano Shinji
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Suzuki Susumu
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Takeshita Kyosuke
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Sakai Shinichi
- Department of Cardiology, Nagoya University Graduate School of Medicine
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- Amano Tetsuya
- Department of Cardiology, Aichi Medical University School of Medicine
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- Matsubara Tatsuaki
- Department of Internal Medicine, School of Dentistry Aichi Gakuin University
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- Murohara Toyoaki
- Department of Cardiology, Nagoya University Graduate School of Medicine
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抄録
Microvascular dysfunction after primary percutaneous coronary intervention (PCI) augments myocardial damage and prognosis in acute myocardial infarction. However, the relationship between baseline anemia and coronary microcirculation in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. We performed primary PCI in 337 consecutive patients with STEMI. Anemia was defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women. Admission anemia was present in 17.5% of the patients enrolled. Data on epicardial coronary flow, STsegment resolution (STR) on electrocardiography, myocardial injury, and the incidence of adverse cardiac events defined as cardiac death or hospitalization for congestive heart failure were analyzed. The median follow-up period was 54.8 months. Despite comparable epicardial coronary flow, the rate of STR ≥ 50% was lower in anemic patients compared with non-anemic patients (55.9% versus 71.2%, P = 0.02). On multivariate logistic regression analysis, baseline anemia was an independent negative predictor of STR ≥ 50% (odds ratio, 0.53; 95% confidence interval: 0.31-0.92, P = 0.03). Moreover, anemic patients had higher maximum creatine kinase levels normalized for body surface area (2,215 ± 1,318 IU/L/m2 versus 1,797 ± 1,199 IU/L/m2, P = 0.047). Anemia remained an independent significant predictor of adverse events on multivariate Cox proportional hazard analysis (hazard ratio, 2.34; 95% confidence interval: 1.01-5.64, P = 0.048). In conclusion, admission anemia was related to microcirculatory dysfunction and poor prognosis in patients with STEMI. The decreased oxygen delivery might exacerbate microvascular function.
収録刊行物
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- International Heart Journal
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International Heart Journal 56 (4), 381-388, 2015
一般社団法人 インターナショナル・ハート・ジャーナル刊行会
