Aims Anaemia is common in patients with acute myocardial infarction (MI). We investigated the association of high-sensitivity cardiac troponin (hs-cTn) and haemoglobin (Hb) and the influence of anaemia on the performance of diagnostic protocols for suspected MI. Methods and results Patients with suspected MI were consecutively enrolled at a tertiary centre. Final diagnoses were independently adjudicated by two cardiologists. Performance measures of hs-cTn-based algorithms were compared for anaemic and non-anaemic patients (Hb <12 g/dL in women and <13 g/dL in men). The influence of anaemia on survival (median follow-up 1.7 years) was investigated using multivariable cox-regression analysis and the association of Hb and hs-cTn by multivariable linear regression analysis. Overall, 2223 patients were included, of whom 415 (18.7%) had anaemia. In anaemic patients, the incidence of MI was similar; however, chronic myocardial injury was significantly more prevalent (20.1% vs. 48.2%). The negative predictive value to rule-out MI was similar for both algorithms and all assays in patients with anaemia, although the positive predictive value to rule-in MI was partly reduced for the 0/3-h algorithm. Fewer anaemic patients were triaged after 1 h. Anaemia was an independent predictor of death. Adjusted for patient characteristics, Hb was significantly associated with hs-cTn. By providing a point-based tool, the Hb-associated hs-cTn concentration and thus chronic myocardial injury may be predicted. Conclusion Anaemia partly affects the rule-in, but not the rule-out of MI in hs-cTn-based diagnostic protocols. Hs-cTn concentrations and thus chronic myocardial injury may be predicted by clinical variables and Hb. Trial registration clinicaltrials.gov (NCT02355457 and NCT03227159).

中文翻译：

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贫血与超敏心肌肌钙蛋白的关系及其对心肌梗死诊断的影响

目的 贫血在急性心肌梗死 (MI) 患者中很常见。我们调查了高敏心肌肌钙蛋白 (hs-cTn) 和血红蛋白 (Hb) 的关联，以及贫血对疑似 MI 诊断方案性能的影响。方法和结果 疑似心肌梗死的患者连续入读三级中心。最终诊断由两名心脏病专家独立裁定。针对贫血和非贫血患者（女性 Hb <12 g/dL 和男性 <13 g/dL）比较了基于 hs-cTn 算法的性能测量。使用多变量 cox 回归分析和多变量线性回归分析 Hb 和 hs-cTn 的关联，研究了贫血对生存的影响（中位随访 1.7 年）。总体而言，共纳入 2223 名患者，其中 415 名（18. 7%）患有贫血。在贫血患者中，心肌梗死的发生率相似；然而，慢性心肌损伤更为普遍（20.1% vs. 48.2%）。排除 MI 的阴性预测值对于贫血患者的算法和所有检测相似，但排除 MI 的阳性预测值在 0/3 小时算法中部分降低。1 小时后分诊的贫血患者较少。贫血是死亡的独立预测因素。根据患者特征调整后，Hb 与 hs-cTn 显着相关。通过提供基于点的工具，可以预测 Hb 相关的 hs-cTn 浓度，从而预测慢性心肌损伤。结论 贫血部分影响基于 hs-cTn 的诊断方案中 MI 的排除，但不影响 MI 的排除。临床变量和 Hb 可以预测 Hs-cTn 浓度和慢性心肌损伤。试验注册临床试验.gov（NCT02355457 和 NCT03227159）。