Association of In‐Hospital Hemoglobin Drop With Decreased Myocardial Salvage and Increased Long‐Term Mortality in Patients With Acute ST‐Segment–Elevation Myocardial Infarction

Abstract

Background Anemia and blood loss occur often in patients with ST‐segment–elevation myocardial infarction (STEMI). In‐hospital hemoglobin drop is associated with 1‐year mortality in patients with acute coronary syndrome. However, data on the effect of hemoglobin reduction on myocardial salvage and long‐term outcomes are scarce. We investigated the impact of in‐hospital hemoglobin drop on myocardial salvage and 5‐year mortality in patients with STEMI treated with primary percutaneous coronary intervention. Methods and Results In‐hospital hemoglobin drop was defined as a decrease in hemoglobin levels from admission and nadir hemoglobin values. Patients were categorized as having the following: no drop, minimal drop (<3 g/dL), minor drop (≥3 to <5 g/dL), and major drop (≥5 g/dL). Myocardial area at risk and infarct size were measured using serial single‐photon emission computerized tomography imaging. The co‐primary outcomes were myocardial salvage and 5‐year all‐cause mortality. Of 1204 patients, 1169 (97.1%) showed a hemoglobin drop during hospitalization: minimal, minor, and major drop occurred in 894 (74.3%), 214 (17.8%), and 61 (5.1%) patients, respectively. Myocardial salvage was reduced in patients with minimal (median, 0.53 [interquartile range, 0.27–0.83]), minor (median, 0.40 [interquartile range, 0.18–0.62]), and major (median, 0.40 [interquartile range, 0.14–0.77]) drop compared with patients without drop (median, 0.70 [interquartile range, 0.44–1.0], P <0.001). After adjusting for covariates, hemoglobin drop remained an independent correlate of poor myocardial salvage. A drop of ≥3 g/dL was associated with reduced left ventricular function at 6 months and with increased mortality at 5‐year follow‐up after STEMI. Conclusions In patients with STEMI undergoing primary percutaneous coronary intervention, in‐hospital hemoglobin drop was associated with reduced myocardial salvage, left ventricular function, and increased long‐term mortality.

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.…”

Prediction models for major adverse cardiovascular events following ST-segment elevation myocardial infarction and subgroup-specific performance

“…The predictive value of the hemoglobin concentration in MI prognosis has been reported ( 22 , 23 ). Here, a similar U-shaped association between the hemoglobin concentration at admission and MACEs following STEMI was observed ( 24 ).…”

Hemoglobin to red cell distribution width ratio as a prognostic marker for ischemic stroke after mechanical thrombectomy

“…Evidence suggests that severe anemia substantially raises the likelihood of stent thrombosis ( Pilgrim et al, 2012 ), and lower Hb level was a strong predictor of post-PCI in-stent restenosis ( Hu et al, 2021 ). Several studies have highlighted baseline Hb as a significant predictor of mortality and ischemic events in PCI ( Reinecke, 2003 ; Dutsch et al, 2022 ). Additionally, a U-shaped association has been found between Hb levels and poor prognosis, all-cause mortality, and stroke severity in ischemic stroke ( Chang et al, 2020 ; Zhang et al, 2021 ).…”