Coronary artery disease
Effect of Anemia in High-Risk Groups of Patients With Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2009.10.036Get rights and content

The significance of anemia in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) remains controversial. The aim of the present study was to evaluate the effect of anemia on the short- and long-term prognosis of patients with AMI treated with PCI, including high-risk subgroups. The study group consisted of 1,497 consecutive patients with AMI treated in the acute phase with PCI. Anemia was defined using World Health Organization criteria (hemoglobin level <13 g/dl for men and <12 g/dl for women). The study population was divided into 2 major groups (patients with [n = 248, 16.6%] and without [n = 1,249, 83.4%] anemia) and 6 subgroups (diabetes mellitus, impaired renal function, age >70 years, left ventricular dysfunction, incomplete revascularization, and multivessel disease). A comparative analysis was performed between both groups within the whole population and within the particular subgroups. Significantly greater 30-day (13.2% vs 7.3%), 1-year (20.5% vs 11.3%), and total (24.1% vs 12.7%; all p <0.05) mortality rates were observed in the anemic group. Multivariate analysis identified anemia as an independent predictor of any-cause death in the whole population during the observation period (covariate-adjusted hazard ratio 1.46, 95% confidence interval 1.31 to 1.61, p <0.05). Anemia was significantly associated with excessive long-term mortality in the multivessel disease group (adjusted hazard ratio 1.54, 95% confidence interval 1.34 to 1.74) and in the incomplete revascularization group (hazard ratio 1.67, both p <0.05). In conclusion, anemia on admission in patients with AMI treated in the acute phase with PCI was independently associated with increasing short- and long-term mortality, especially in the subgroups with incomplete revascularization and multivessel disease.

Section snippets

Methods

The study group consisted of 1,497 consecutive patients, who were admitted to our department from September 2004 to December 2007 with AMI and treated in the acute phase with PCI. The clinical criteria of AMI evaluated on admission were chest pain persisting for >20 minutes, ST-segment elevation of ≥0.1 mV in 2 continuous electrocardiographic leads, or non–ST-segment elevation and enzymatic confirmation of AMI. Patients were mainly admitted from referral hospitals. All patients were included in

Results

The patients with anemia were older, more likely to be women, and to have a lower body mass index and greater baseline serum creatinine. They were more likely to have history of myocardial infarction, PCI, and diabetes and were less likely to have history of smoking. They presented with a higher Killip class and longer lasting symptoms of AMI before admission. The clinical characteristics of the study population are listed in Table 1.

Patients with anemia had more advanced coronary artery

Discussion

Most previous studies have demonstrated an association between anemia and MACE.15, 18, 19, 20 However, most of these studies concerned patients with stable angina, which might explain the low in-hospital cardiac mortality.15, 18 Reinecke et al18 examined the relation between the hemoglobin concentration and in-hospital and long-term survival after PCI in 689 male patients. In their study, the in-hospital mortality rate was very low (0% to 0.7%) and was not significantly influenced by the

References (28)

  • P. Ponikowski et al.

    Effect of darbepoetin alfa on exercise tolerance in anemic patients with symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled trial

    J Am Coll Cardiol

    (2007)
  • J.H. Chesebro et al.

    Thrombolysis In Myocardial Infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase: clinical findings through hospital discharge

    Circulation

    (1987)
  • W.C. Wu et al.

    Blood transfusion in elderly patients with acute myocardial infarction

    N Engl J Med

    (2001)
  • E. Joosten et al.

    Prevalence and causes of anaemia in a geriatric hospitalized population

    Gerontology

    (1992)
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