Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry

Abstract

BackgroundWe aim to determine the prevalence of anemia in acute coronary syndrome (ACS) patients and compare their clinical characteristics, management, and clinical outcomes to those without anemia in an unselected national ACS cohort.Methods and ResultsThe Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30‐day mortality with 1 g/dL incremental hemoglobin increase and the 30‐day and 1‐year mortality for anemic compared to nonanemic groups. Analyses were adjusted for covariates. Our analysis of 422 855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic and that these patients are older, have a greater prevalence of renal disease, peripheral vascular disease, diabetes mellitus, and previous acute myocardial infarction, and are less likely to receive evidence‐based therapies shown to improve clinical outcomes. Finally, our analysis suggests that anemia is independently associated with 30‐day (OR 1.28, 95% CI 1.22‐1.35) and 1‐year mortality (OR 1.31, 95% CI 1.27‐1.35), and we observed a reverse J‐shaped relationship between hemoglobin levels and mortality outcomes.ConclusionsThe prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multimorbid and less likely to receive evidence‐based therapies shown to improve clinical outcomes, with the presence of anemia independently associated with mortality outcomes.

Cedera Hati Hipoksik Prediktor Komplikasi Akut Utama Pasien Infark Miokard di Unit Rawat Intensif Koroner Rumah Sakit Cipto Mangunkusumo

“…18 mendapatkan adanya hubungan yang kuat antara peningkatan LDL dan kejadian MACE pada pasien SKA. Sementara itu, Mamas 19 melaporkan bahwa anemia memengaruhi mortalitas pasien SKA.…”

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

“…Sabatine et al examined the 30 day cardiovascular mortality in patients with STEMI categorized by 1 g/dL hemoglobin increments and found a J‐shaped relationship with increased mortality at hemoglobins below 140 g/L and above 170 g/L. A more recent British retrospective study confirmed both the optimal hemoglobin range and the J shaped relationship with 30‐day mortality in 71 223 patients presenting with anemia and ACS . In our smaller population we too found a close association between hemoglobin and mortality after adjustment for comorbidities.…”

Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India

“…There is a strong biological rationale for anemia as a prognostic predictor in ACS patients. Reduced ability to carry oxygen to an already under-perfused myocardium [9], impaired vascular healing [10], increased inflammatory influx [11], heightened risk of thrombosis [12], need for whole blood or packed cell transfusions [13], and differing medication profiles [14,15] can all contribute to adverse outcomes in ACS patients with anemia. Considering these mechanistic explanations, anemia can be expected to influence both shortterm and long-term outcomes after ACS [16][17][18].…”