Effect of anemia on 1-year mortality in patients with acute myocardial infarction

Falluji, Nezar; Lawrence-Nelson, Janet; Kostis, John B.; Lacy, Clifton R.; Ranjan, Rajiv; Wilson, Alan C.

doi:10.1067/mhj.2002.124351

Cited by 50 publications

(45 citation statements)

References 17 publications

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“…In one study that examined a database of discharge abstract information in patients admitted with MI, those identified as anemic on the basis of International Classification of Diseases, 9th Revision (ICD-9) coding were not found to have a higher mortality. 11 In contrast, in a large database study of elderly Medicare beneficiaries with acute MI in which actual hematocrit data were used, a powerful, albeit unadjusted, relationship between hematocrit on admission and all-cause 30-day mortal- ity was found. Similar to the present study, there was a dose-response effect, with progressively lower survival rates with more profound degrees of anemia.…”

Section: Discussionmentioning

confidence: 97%

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Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

et al. 2005

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Background— In the setting of an acute coronary syndrome (ACS), anemia has the potential to worsen myocardial ischemia; however, data relating anemia to clinical outcomes in ACS remain limited. Methods and Results— We examined the association between baseline hemoglobin values and major adverse cardiovascular events through 30 days in 39 922 patients enrolled in clinical trials of ACS. After adjustment for differences in baseline characteristics and index hospitalization treatments, a reverse J-shaped relationship between baseline hemoglobin values and major adverse cardiovascular events was observed. In patients with ST-elevation myocardial infarction, when those with hemoglobin values between 14 and 15 g/dL were used as the reference, cardiovascular mortality increased as hemoglobin levels fell below 14 g/dL, with an adjusted OR of 1.21 (95% CI 1.12 to 1.30, P <0.001) for each 1-g/dL decrement in hemoglobin. At the other end of the range of hemoglobin, patients with hemoglobin values >17 g/dL also had excess mortality (OR 1.79, 95% CI 1.18 to 2.71, P =0.007). In patients with non–ST-elevation ACS, with those with hemoglobin 15 to 16 g/dL used as the reference, the likelihood of cardiovascular death, myocardial infarction, or recurrent ischemia increased as the hemoglobin fell below 11 g/dL, with an adjusted OR of 1.45 (95% CI 1.33 to 1.58, P <0.001) for each 1 g/dL decrement in hemoglobin. Patients with hemoglobin values >16 g/dL also had an increased rate of death or ischemic events (OR 1.31, 95% CI 1.03 to 1.66, P =0.027). Conclusions— Anemia is a powerful and independent predictor of major adverse cardiovascular events in patients across the spectrum of ACS.

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Section: Discussionmentioning

confidence: 97%

“…10 To this point, few studies have specifically examined anemia in patients with ACS. 2,[11][12][13][14] We therefore examined the association between baseline hemoglobin concentration and a range of cardiovascular clinical outcomes in a broad cohort of nearly 40 000 patients across the spectrum of ACS.…”

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confidence: 99%

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

et al. 2005

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“…Indeed, other studies have also suggested that associations between anemia and mortality were due to residual confounding. 1,21 A similar pattern was observed when we examined the impact of discharge anemia and PF. In particular, we found lower PF at baseline, 6 mo, and 12 mo among those with discharge anemia; however, these differences also did not persist after multivariable adjustment.…”

Section: Discussionmentioning

confidence: 56%

Impact of Anemia on Physical Function and Survival Among Patients with Coronary Artery Disease

Patel¹,

Grab²,

Kosiborod³

et al. 2008

Clinical Cardiology

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Background: Anemia is a purported risk factor for adverse outcomes, particularly among patients with cardiac disease. Although anemia at the time of discharge has been associated with poor functional status and survival, its impact over time is not clear. Hypothesis: Among patients with significant coronary artery disease (CAD), anemia (hemoglobin <11 g/dL) is prevalent, and is associated with poor physical function (PF) and survival over time. Methods: Patients with significant CAD at the time of cardiac catheterization (n = 1,821) were enrolled into a single-center, observational, and prospective study. All patients were followed for up to 1 y for clinical events and self-reported PF. Prevalence of anemia at discharge and its' associations with outcomes over time were examined. Results: Anemia at the time of discharge was very common (40.4%), and was associated with increased odds of death at 12 mo (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.12-2.15), yet other clinical factors accompanying anemia accounted for this association (adjusted OR 1.13, 95% CI 0.79-1.62). Discharge anemia was also associated with significantly lower self-reported PF at 6 and 12 mo (p<0.05 for both); however, other clinical factors accompanying anemia also accounted for these associations. Conclusions: Although discharge anemia is highly prevalent, its association with adverse outcomes is largely explained by baseline patient characteristics. Further research is needed to clarify the relationship between anemia and outcomes in this population and to identify subpopulations that do not recover independently and for whom available therapies may be beneficial.

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“…When haemoglobin, as a main oxygen carrier, concentration decreases, body may increase cardiac output to maintain the normal metabolic demands of tissues, which increases cardiac work, and result in myocardial damage [11,12]. The relationship between haemoglobin concentrations and cardiovascular outcomes has been reported in a broad cohort of patients with ACS [13,14]. But the exact underlying patho-mechanisms between low haemoglobin concentrations and adverse cardiovascular outcomes are not well recognized.…”

Section: Discussionmentioning

confidence: 99%

Admission Haemoglobin Levels and Its Related Factors at Percutaneous Coronary Intervention for the Management of Acute Coronary Syndrome in Octogenarian Patients: Assessment of Gender Differences and In-Hospital Outcomes

Yıldız¹

2012

J Clin Exp Cardiolog

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Anaemia has the potential to worsen the myocardial ischemia in acute coronary syndrome. In this paper, admission haemoglobin levels and the factors related to haemoglobin concentrations and in-hospital outcomes of percutaneous coronary intervention were analysed for the management of acute coronary syndrome in female and male octogenarian patients. We analyzed data of 2.256 consecutive patients who underwent percutaneous coronary intervention with bare metal and/or drug eluting stent implantation. Either the femoral artery or brachial artery approach was used. 50 of 2256 consecutive patients were octogeneric and Hb and white blood cell levels were analyzed. Mean admission haemoglobin levels were significantly elevated in male octogenarian patients as compared with female octogenarian patients (12.10 ± 1.37 mg/dl, 11.24 ± 1.03 mg/dl, p=0.02, respectively). Pearson correlation analysis between haemoglobin and clinical, angiographic, procedural characteristics, biochemical and hematologic values showed that haemoglobin was only correlated negatively with leukocytes (r=-0.35; p=0.01). Admission haemoglobin concentrations were significantly elevated in male octogenarian patients as compared with female. Only blood leukocyte levels were found to be significantly associated with haemoglobin concentration. Therefore, anaemia and leucocytosis may be associated with worse in-hospital outcomes at percutaneous coronary intervention for the management of acute coronary syndrome in female octogenarian patients.

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Effect of anemia on 1-year mortality in patients with acute myocardial infarction

Cited by 50 publications

References 17 publications

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes

Impact of Anemia on Physical Function and Survival Among Patients with Coronary Artery Disease

Admission Haemoglobin Levels and Its Related Factors at Percutaneous Coronary Intervention for the Management of Acute Coronary Syndrome in Octogenarian Patients: Assessment of Gender Differences and In-Hospital Outcomes

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