Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background. Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods. We analyzed records of 983 STEMI patients who were treated with primary PCI. e primary end point was all-cause mortality at 1 year and 2 years. e relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results. Overall, 16.4% of patients had bleeding events, which were classified by the rombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. e incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P < 0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb � 1.020, 95% confidence interval (CI): 1.006-1.034, P � 0.004) and in a confounder-adjusted model (HR per 1 g/L decrease in discharge Hb � 1.024, 95% CI: 1.011-1.037, P < 0.001). e odds ratio (OR) for all-cause mortality at 2 years for participants with Hb below the twentieth percentile was 3.529 (95% CI: 1.976-6.302) and 2.968 (95% CI: 1.614-5.456) after adjustment for age and gender and 2.485 (95% CI: 1.310-4.715) after adjustment for all covariates. Conclusions. In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.

Outcomes of Left Main Revascularization in Patients with Anemia: Gulf Left Main Registry

“…Few studies have looked into discharge Hb and long-term outcomes. Gao et al reported that 2-year all-cause mortality increased in patients who underwent PCI and had lower discharge Hb [36]. Their bleeding events rate was comparable to ours with 16.4% of patients having TIMI bleeding events, though no significant gastrointestinal bleeding and cerebral hemorrhage were reported [36].…”

“…Gao et al reported that 2-year all-cause mortality increased in patients who underwent PCI and had lower discharge Hb [36]. Their bleeding events rate was comparable to ours with 16.4% of patients having TIMI bleeding events, though no significant gastrointestinal bleeding and cerebral hemorrhage were reported [36]. Other studies have not shown an association between discharge Hb and medium-term survival in patients who underwent CABG [37].…”

Predicting left ventricular remodeling post-MI through coronary physiological measurements based on computational fluid dynamics

“… 18 , 19 Hemoglobin levels at admission have been reported to be associated with cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI), with lower levels associated with an increased risk of adverse events, including LVR. 20 , 21 Our study further supports the importance of these factors in predicting LVR, which may help clinicians identify high-risk patients and optimize their management.…”

Impact of anemia on clinical outcomes of patients with atrial fibrillation: The COOL‐AF registry

“…Anemia might be a risk factor for adverse events in many cardiovascular conditions, such as heart failure, 13,14 CAD after acute coronary syndrome 15 or percutaneous coronary intervention (PCI), especially when the patient requires antiplatelet medication 16 . It might also increase the risk of bleeding complication.…”