Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Farhan, Serdar; Baber, Usman; Mehran, Roxana

doi:10.1161/jaha.116.004908

Cited by 21 publications

(21 citation statements)

References 18 publications

(18 reference statements)

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“…Anemia limits oxygen delivery to the heart and other tissues and increases the oxygen supply-demand mismatch. A malfunctioning hypo-perfused cardiac tissue will result in reduced cardiac performance, and will further worsen the oxygen supply to other tissues [11]. Other plausible explanations may be the tendency of physicians to prefer clopidogrel over the more potent P2Y12 inhibitors ticagrelor or prasugrel in anemic patients, or use dual anti-platelet agents for shorter durations than recommended by contemporary guidelines.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome

Moady

Iakobishvili

Beigel

et al. 2019

Journal of Cardiology

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A B S T R A C TBackground: The GRACE risk score is currently recommended as the major score for risk prediction on admission in patients with acute coronary syndrome (ACS). Anemia in patients with ACS adversely affects their clinical outcomes, yet hemoglobin level on admission is not included as a parameter in the GRACE score. We hypothesized that hemoglobin level on admission would improve the predictive value of the GRACE score. Methods: We retrospectively studied one-year mortality in consecutive ACS patients included in the ACSIS (acute coronary syndrome Israeli Survey) registry between the years 2008 and 2013. Patients were classified into groups according to the GRACE score -!140 or <140, and according to the hemoglobin level: severe anemia -<8 g/dl; mild anemia -8-12 g/dl; no anemia ->12 g/dl. We analyzed the incremental predictive value of admission hemoglobin levels over the GRACE score. Results: We studied 11,505 patients. The GRACE score predicted 1-year mortality with an area under the curve (ROC) of 0.68 (95% CI 0.66-0.7). When hemoglobin level on admission was incorporated into the model, the ROC increased to 0.73 (95% CI 0.71-0.75, p < 0.001). The incremental value of hemoglobin levels on admission was significant only in the low (<140) GRACE score group. Conclusions: In patients a with low GRACE score (<140), anemia on admission has additional predictive value for one-year mortality. In contrast, in patients with a high GRACE risk score, hemoglobin level on admission did not improve prediction accuracy.

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Section: Discussionmentioning

confidence: 99%

The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome

Moady

Iakobishvili

Beigel

et al. 2019

Journal of Cardiology

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“…However, higher mortality could not be fully explained by the treatment difference between anemic and nonanemic STEMI patients [ 47 ]. Randomized control trials reveal that transfusing patients with Hb levels between 9 g/dL and 10 g/dL shows no advantage over transfusing patients with Hb levels between 7 g/dL and 8 g/dL [ 60 ]. Another study revealed that transfusion is not beneficial and may end up harming patients with cardiovascular disease or Hb levels of more than 10 g/dL [ 59 ].…”

Section: Reviewmentioning

confidence: 99%

Acute Anemia and Myocardial Infarction

Padda¹,

Khalid²,

Hitawala³

et al. 2021

Cureus

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Various studies have established the prognosis of anemia in myocardial infarction (MI). Both chronic and acute anemia lead to poor outcomes in MI. Regardless, the association of anemia with MI and its management varies. In this study, the literature was analyzed to determine the association between acute anemia and MI based on the pathophysiology, outcomes, and management options. Acute anemia results in decreased blood supply and sudden hypoxia to the heart. Additionally, it exacerbates the preexisting compromised coronary blood supply in patients with MI. Thus, there is a disproportionate oxygen supply and demand ratio to the heart. It was found that anemia increases all-cause mortality in acute MI. However, it is unclear whether anemia is the direct contributor to mortality in these patients. For the management of MI, percutaneous coronary intervention (PCI) is commonly used. Increased incidence of hospital-acquired anemia (HAA) is reported in patients after PCI. However, the cause of HAA in these patients is not well established. Antiplatelet therapy in these patients is also considered to be the culprit for HAA. Nonetheless, no clear evidence is available. There is no consensus or criteria for the treatment of acute anemia in MI patients. Researchers have explored management options such as blood transfusion, erythropoietin-stimulating agent, and iron therapy. Further studies are warranted for a better understanding and management of MI in patients with anemia and vice versa.

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“…From a theoretical point of view, transfusing RBC increases oxygen delivery to the vulnerable myocardium, reducing ischemic symptoms, but few confirmatory data exist. 31 …”

Section: Anemia and Acs: To Treat Or Not To Treat?mentioning

confidence: 99%

Anemia and acute coronary syndrome: current perspectives

Stucchi¹,

Cantoni²,

Piccinelli³

et al. 2018

VHRM

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Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of <13 g/dL for adult men and <12 g/dL for adult nonpregnant women. Subsequent studies identified different normal values according to race and age. Estimated prevalence of anemia on admission in the setting of an acute coronary syndrome (ACS) is between 10% and 43% of the patients depending upon the specific population under investigation. Furthermore, up to 57% of ACS patients may develop hospital-acquired anemia (HAA). Both anemia on admission and HAA are associated with worse short- and long-term mortality, even if different mechanisms contribute to their prognostic impact. Baseline anemia can usually be traced back to preexisting disease that should be specifically investigated and corrected whenever possible. HAA is associated with clinical characteristics, medical therapy and interventional procedures, all eliciting cardiovascular adaptive response that can potentially worsen myocardial ischemia. The intrinsic fragility of anemic patients may limit aggressive medical and interventional therapy due to an increased risk of bleeding, and could independently contribute to worse outcome. However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS. Besides identification and treatment of the underlying causes of anemia, the only readily available means to reverse anemia is red blood cell transfusion. The adequate transfusion threshold is still being debated, although solid evidence suggests reserving red blood cell transfusions for patients with Hb level <8 g/dL and considering it in selected cases with Hb levels of between 8 and 10 g/dL. No evidence supports the use of iron supplements and erythropoiesis-stimulating agents in the setting of ACS.

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Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Cited by 21 publications

References 18 publications

The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome

The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome

Acute Anemia and Myocardial Infarction

Anemia and acute coronary syndrome: current perspectives

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