Abstract 15178: Impact of Anemia on Mortality Among Patients With Type 2 Myocardial Infarction

Abstract

Introduction: Anemia, a common precipitant of Type 2 Myocardial Infarction (T2MI), is well studied in Acute Coronary Syndrome (ACS), but its impact on mortality in T2MI population is lacking. We evaluated the association of hemoglobin (Hgb) levels on all-cause mortality within 60 days in patients with T2MI. Methods: In this single-center retrospective study, we evaluated 812 patients with Hgb > 7g/dl and troponin >0.04 ng/L (>99 th percentile) presenting to a tertiary ED from 08/2016-08/2018. Exclusion criteria included patients with ischemic EKG changes, ACS treatment, cardiac catheterization showing intervenable lesions. Adjusted confounding variables are included in the figure. Iterative code was created to test each possible Hgb cut-off, from 7.1 to 15.2, to maximize the area under the curve while also looking for the smallest p-value and largest odds ratio. Five Hgb categories were then created, and mortality was calculated across groups. A multivariate-adjusted logistic regression model was used to predict mortality using Hgb category 13+ as the reference group. Results: Cut-off analysis showed Hgb of 9.9 as an inflection point of maximal mortality benefit (p<0.0001). Thus, our Hgb categories were 7-9.9, 10-10.9, 11-11.9, 12-12.9, and 13+. 60-day mortality rate for the above respective groups were 45.4% (n=216), 40.0% (n=135), 36.5% (n=104), 34.8% (n=115), and 26.9% (n=242) respectively. The overall 60-day mortality was 36.3% (295/812). In comparison with the reference group, multivariate analysis showing ORs for 60-day mortality for the above Hgb categories were 1.92 (95% CI: 1.28-2.96, p-0.003), 1.42 (0.87-2.32, p-0.16), 1.46 (0.86-2.49, p0.16), and 1.46 (0.88-2.42, p-0.15) respectively. Conclusions: Hospitalized patients with T2MI have an exceptionally high mortality rate that independently correlate with anemia severity. Those with Hgb < 9.9 had significantly higher mortality compared to Hgb > 9.9.