Iron deficiency for prognosis in acute coronary syndrome – A systematic review and meta-analysis

Reinhold, Johannes; Papadopoulou, Charikleia; Baral, Ranu; Vassiliou, Vassilios

doi:10.1016/j.ijcard.2020.12.021

Cited by 23 publications

(12 citation statements)

References 28 publications

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“…ID is a prevalent condition with 43% in a meta-analysis of patients with ACS. 10 A limited number of studies reported on prognosis in the presence of baseline ID and showed increased risk for CV events. 10 Furthermore, Meroño et al 8 also showed that ID results in worse exercise capacity and worse quality of life in the recovery phase post-ACS, although no effect on CV morbidity or mortality was shown.…”

Section: Discussionmentioning

confidence: 99%

“…10 A limited number of studies reported on prognosis in the presence of baseline ID and showed increased risk for CV events. 10 Furthermore, Meroño et al 8 also showed that ID results in worse exercise capacity and worse quality of life in the recovery phase post-ACS, although no effect on CV morbidity or mortality was shown. A retrospective subgroup analysis of 836 patients with ACS (29% ID) from the AtheroGene cohort study showed a 52% increased risk for CV mortality or MI during 4-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…analysis, comprising a total of 7 studies on 2,821 participants with acute coronary syndrome (ACS), showed that patients with baseline ID may have worse prognosis. 10 Nevertheless, these previous studies have an important caveat because baseline ID is a binary snapshot of iron status that fails to capture the dynamic process of iron homeostasis and disease progression. Therefore, we applied a joint model approach to investigate if the temporal pattern of iron status based on repeatedly measured biomarkers is associated with prognosis in patients post-ACS admission.…”

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confidence: 99%

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Relation of Iron Status to Prognosis After Acute Coronary Syndrome

Gürgöze

Kardys

Akkerhuis

et al. 2022

The American Journal of Cardiology

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Iron deficiency has been extensively researched and is associated with adverse outcomes in heart failure. However, to our knowledge, the temporal evolution of iron status has not been previously investigated in patients with acute coronary syndrome (ACS). Therefore, we aimed to explore the temporal pattern of repeatedly measured iron, ferritin, transferrin, and transferrin saturation (TSAT) in relation to prognosis post-ACS. BIOMArCS (BIOMarker study to identify the Acute risk of a Coronary Syndrome) is a prospective, multicenter, observational cohort study conducted in The Netherlands between 2008 and 2015. A total of 844 patients with post-ACS were enrolled and underwent high-frequency (median 17) blood sampling during 1 year follow-up. Biomarkers of iron status were measured batchwise in a central laboratory. We analyzed 3 patient subsets, including the casecohort (n = 187). The primary endpoint (PE) was a composite of cardiovascular mortality and repeat nonfatal ACS, including unstable angina pectoris requiring revascularization. The association between iron status and the PE was analyzed using multivariable joint models. Mean age was 63 years; 78% were men, and >50% had iron deficiency at first sample in the case-cohort. After adjustment for a broad range of clinical variables, 1 SD decrease in log-iron was associated with a 2.2-fold greater risk of the PE (hazard ratio 2.19, 95% confidence interval 1.34 to 3.54, p = 0.002). Similarly, 1 SD decrease in log-TSAT was associated with a 78% increased risk of the PE (hazard ratio 1.78, 95% confidence interval 1.17 to 2.65, p = 0.006). Ferritin and transferrin were not associated with the PE. Repeated measurements of iron and TSAT predict risk of adverse outcomes in patients with post-ACS during 1 year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Relation of Iron Status to Prognosis After Acute Coronary Syndrome

Gürgöze

Kardys

Akkerhuis

et al. 2022

The American Journal of Cardiology

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“…Iron de ciency was de ned as: ferritin <100ng/mL or 100-300ng/mL with transferrin saturation (Tfs) <20% [28]. Ferritin were categorized in low (<30ng/mL; women CAD/Control n=6/40, male CAD/Control n=6/8), normal (30-200ng/mL in women; CAD/Control n=168/197, and 30-300ng/mL in men; CAD/Control n=204/304), and high (>200ng/mL in women, CAD/Control n=120/25, and >300ng/mL in men; CAD/Control n=139/69) ferritin levels [21,[29][30][31]. Selective cardioangiography (CAG) was performed in all patients using the standard Judkins technique.…”

Section: Methodsmentioning

confidence: 99%

Low Serum Iron Status Is Associated With Low Incidence of Coronary Artery Disease In Women

Guo

Mao

et al. 2022

Preprint

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Background: Disorders of iron metabolism has been implicated in cardiovascular disease. However, the association of serum ferritin and coronary artery disease (CAD) remains inconsistent. Here, we investigated the associations of serum iron metabolism with the incidence of CAD, the severity of coronary artery stenosis, metabolic biomarkers, and 1-year restenosis after coronary artery revascularization. Methods: A total of 643 CAD patients and 643 healthy controls were enrolled to assess the associations of serum iron status with the presence of CAD, the severity of CAD, and 1-year rehospitalization after revasculation. Serum iron metabolism and other metabolic markers were measured in all subjects. All statistical analyses were analyzed using SPSS22.0 software and STATA statistical package.Results: Serum level of iron metabolism markers, including serum iron, ferritin, unsaturated transferrin iron binding capacity (UIBC), Total iron binding capacity (TIBC) levels, in CAD groups was significantly higher than the control group (P<0.001). UIBC and TIBC were negatively correlated with ferritin in both sexes. Serum level of iron (OR=0.806, 95% CI (0.687-0.944), UIBC (OR=0.919, 95% CI (0.852-0.992), and TIBC (OR=0.864, 95% CI (0.787-0.95) were found to have a protective role for CAD in women (P<0.05, Table 3). The OR for ferritin was significant in the both sexes (OR=1.029, 95% CI (1.002-1.058) in men, OR=1.02, 95% CI (1.005-1.034) in women, P<0.05). Conclusion: Low Serum level of iron, UIBC, TIBC and ferritin levels were found to have a protective role for CAD in women, but not in men. Elevated serum ferritin is independently and positively associated with CAD in men and women.

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“…Concerning the prognostic value of iron deficiency in acute coronary syndromes (ACS), a recent meta-analysis of seven studies recorded a higher risk of adverse outcomes during long-term follow-up in patients with iron deficiency [ 11 ]. However, ferritin was rarely used in defining iron deficiency in analysed studies, and this meta-analysis did not focus primarily on patients with AMI.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

et al. 2022

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The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI.

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Iron deficiency for prognosis in acute coronary syndrome – A systematic review and meta-analysis

Cited by 23 publications

References 28 publications

Relation of Iron Status to Prognosis After Acute Coronary Syndrome

Relation of Iron Status to Prognosis After Acute Coronary Syndrome

Low Serum Iron Status Is Associated With Low Incidence of Coronary Artery Disease In Women

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

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