Abstract
ObjectivesTo assess the impact of different types of anemia and of concomitant non-cardiovascular chronic illnesses on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and baseline anemia admitted to the Intensive Cardiac Care Unit.MethodsBased on the mean corpuscular volume, anemia was stratified into: microcytic (<80 fL), normocytic (≥80, <96 fL), and macrocytic (≥96 fL). Data on concomitant chronic non-cardiovascular illnesses including malignancies were carefully collected. Endpoints included in-hospital bleeding as well as all-cause mortality at long-term follow-up.ResultsOf 1,390 patients with STEMI, 294 patients had baseline anemia (21.2%), in whom normocytic, microcytic, and macrocytic anemia was present in 77.2%, 17.0%, and 5.8% patients, respectively. In-hospital bleeding occurred in 25 (8.5%) of the study population without significant differences between the three groups. At a mean follow-up of 5.5±3.5 years, 104 patients (35.4%) had died. Mortality was the highest in patients with macrocytic anemia, followed by patients with normocytic anemia and microcytic anemia (58.8%, 37.0%, and 20.0%, respectively; P=0.009). Chronic non-cardiovascular condition was identified as an independent predictor of both in-hospital bleeding (odds ratio=2.57, P=0.01) and long-term mortality (hazard ratio [HR] 1.54, P=0.019). Performance of coronary angiography within index hospitalization was associated with lower long-term mortality (HR 0.38, P=0.001). Mean corpuscular volume did not predict either in-hospital bleeding or mortality.ConclusionsChronic non-cardiovascular illnesses are highly prevalent among patients with STEMI and baseline anemia, and are strongly associated with higher in-hospital bleeding and long-term mortality. Type of anemia is not related to prognosis post-STEMI.
Highlights
Anemia is a frequent condition in patients hospitalized for acute coronary syndrome (ACS)
Of 1,390 patients with segment elevation myocardial infarction (STEMI), 294 patients had baseline anemia (21.2%), in whom normocytic, microcytic, and macrocytic anemia was present in 77.2%, 17.0%, and 5.8% patients, respectively
Chronic non-cardiovascular condition was identified as an independent predictor of both in-hospital bleeding and long-term mortality
Summary
Anemia is a frequent condition in patients hospitalized for acute coronary syndrome (ACS). In the contemporary trials and observational studies, anemia at baseline was present in up to one-quarter of the patients and consistently correlated with increased mortality.[1,2,3,4] The reasons for negative impact of anemia on survival of patients with ACS are not known. Several mechanisms have been suggested, including excess of bleeding complications, overactivation of sympathetic nervous system, increased inflammatory response, negative impact of blood product transfusions, association with impaired renal function, and less frequent use of pharmacological agents recognized to improve survival post ACS.[2,5,6,7,8]. Previous studies did not consider the possible impact of different types of anemia and/or of concomitant non-cardiovascular chronic illnesses on outcomes of patients with ACS
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