P213 ROLE OF ANEMIA AND IRON IMPLEMENTATION ON PROGNOSIS AND MANAGEMENT OF ELDERLY STEMI PATIENTS

Abstract

Listen

Translate article

Abstract Introduction Elderly patients with S–T elevation myocardial infarction (STEMI) presented a very high risk for both in–hospital and long–term morbility and mortality. Comorbidities plays a key role in prognosis, in particular anemia (pre–existent or acquired) is a more and more emerging clinical element able to influence short– and long–term clinical outcome. Prognostic role of anemia in elderly STEMI patients in not completely clarified. Purpose of the present study is to evaluate the role of anemia and its therapy by iron implementation in a very–old population of STEMI patients followed for 1 year after index event. Methods we considered all STEMI patients admitted in our Coronary Care Unit from 2020 to 2021 and we selected only people aged > 80 years–old (n = 120). Haemoglobin (Hb, g/dl) values were considered at admission (T0), at hospital discharge (T1) and after 6 month (T2). In hospital and 1 year mortality, treatment by primary PCI, major bleedings (TIMI criteria), need of transfusion, double antiplatelet therapy (DAPT) discontinuation, were considered and compared between groups of patients without and with anemia (A, Hb < 13.5 for men and <12 for women at T1) and without (NA group). Type of iron implementation (sucrosomial or not) and its tolerability were considered only for A group. Data were expressed as means±SD or % values. Results 18 patients (15%) presented anemia at T0 (women 66%), 4 (22%) of them showed a TIMI major in–hospital bleeding (3, 20%, required blood transfusion) whereas 5 (5%) in non anemic, in–hospital mortality was similar between anemic and non–anemic (18% vs 17%). Sixteen (14%) presented mild anemia at T1 (14%, A group), mean age were similar to NA group (years, 86±4 vs 85±5, A vs NA, ns). In A 4 (25%) died during follow–up vs 11 (13%) in NA group during 1 year follow–up. Treatment with primary PTCA (31% vs 39%, A vs NA, ns) were similar. DAPT discontinuation In A group 16 patiens were discharged with indication to long–term iron implementation therapy, 6 of them with sucrosomial. Incidence of iron discontinuation was 16% (1 pt) for sucrosomial vs 50% (5 pts) for non–sucrosomial. Conclusions In elderly STEMI patients, 1) anemia at hospital admission influences in hospital major bleedings and need of blood trasfusions. 2) anemia at hospital discharge seems to affect DAPT discontinuation and long–term mortality. 3) use of sucrosomial iron reduces probability of discontinuation of implementation therapy.