Impact of Early Invasive Approach on Outcomes of Patients With Acute Coronary Syndrome and Baseline Anemia: Analysis From the ACSIS Registry

Abstract

In the setting of ACS, despite the presence of baseline anemia, early coronary angiography with subsequent revascularization, when indicated, was associated with improved clinical outcomes including 1-year mortality without significant increase in rates of major bleeding.

Outcomes of anemic patients presenting with acute coronary syndrome: An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events

“…22 Studies which examine the impact of anemia on patients with ACS treated by primary PCI have found that anemia was a powerful marker of poor prognosis. 1,5,7,10,15,[22][23][24] Though one study suggests that early coronary angiography and PCI in an anemic STEMI cohort was associated with improved clinical outcomes and a comparable incidence of bleeding with the anemic cohort who did not undergo PCI. 15 A more recent retrospective study suggests that timely primary PCI in anemic STEMI patients had no increase in mortality but a penalty of major bleeding when compared to STEMI patients without anemia.…”

“…1,5,7,10,15,[22][23][24] Though one study suggests that early coronary angiography and PCI in an anemic STEMI cohort was associated with improved clinical outcomes and a comparable incidence of bleeding with the anemic cohort who did not undergo PCI. 15 A more recent retrospective study suggests that timely primary PCI in anemic STEMI patients had no increase in mortality but a penalty of major bleeding when compared to STEMI patients without anemia. 24 There is general agreement that the management of ACS patients should incorporate anemia into the overall PCI strategy but there are no guidelines directly addressing this common clinical dilemma.…”

“…There is a strong evidence base supporting their prognostic importance in the ACS cohort however many of these trials have excluded anemic patients. This exclusion has been related to the increased risk of clinically significant bleeding associated with these therapies and this influences the clinician's decision to use these therapies during hospitalization and post discharge despite their proven prognostic benefit albeit in non‐anemic populations . There is literature reporting that anemic patients are under‐treated when presenting with ACS.…”

“…This exclusion has been related to the increased risk of clinically significant bleeding associated with these therapies and this influences the clinician's decision to use these therapies during hospitalization and post discharge despite their proven prognostic benefit albeit in non-anemic populations. [14][15][16][17] There is literature reporting that anemic patients are under-treated when presenting with ACS. The use of aspirin, betablockers, and statins have been shown to be less likely prescribed to anemic ACS patients both in the acute period and in the post discharge period.…”

Anaemia in acute coronary syndrome patients: a study from rural tertiary care centre of India

“…Previous reports have suggested that ACS patients with anaemia have significantly worse inhospital and longer-term total and cardiac mortality outcomes, heart failure, and risk of major bleeding and of reinfarction. [5][6][7][11][12][13][14][15] Some studies have reported that, once differences in age or comorbidity burden between anaemic/non-anaemic ACS cohorts are adjusted for, anaemia is no longer an independent predictor of adverse mortality or cardiovascular mortality, although other studies report that the relationship persists. 6,7,[15][16][17][18] Other studies have reported different relationships between anaemia and cardiovascular (CV) outcomes according to sex, with baseline anaemia independently associated with higher rates of all-cause and cardiac mortality at 30 days and 1 year in men but not in women.…”