Abstract 803: Anemia and Invasive Management Utilization in Acute Non-ST Elevation Myocardial Infarction
Objectives It is unknown how anemia may influence the invasive management of patients with non-ST segment elevation myocardial infarction (NSTEMI) and whether these management practices may influence one-year mortality outcomes.
Methods We used data from the Worcester Heart Attack Study, which included 2,820 patients with confirmed NSTEMI from 11 hospitals in the Worcester (MA) metropolitan area during 1997–2005. Based on admission hematocrit levels, patients were stratified into categories of anemia: <27.0%, 27.0–29.9%, 30.0–32.9%, 33.0–35.9%, and 36.0–38.9%; and no anemia: ≥39.0%, and compared these groups with regards to the use of cardiac catheterization and revascularization (percutaneous intervention or bypass surgery) during hospitalization for NSTEMI. We then related hematocrit levels and coronary revascularization status to the risk of 1-year death post NSTEMI admission.
Results Only patients with admission hematocrit levels <27% had significantly decreased adjusted odds of cardiac catheterization versus those without anemia (table⇓). Among patients who underwent cardiac catheterization, revascularization rates varied between 63–78%, unrelated to hematocrit levels. Compared to those without anemia, revascularization in anemic patients was associated with a significantly higher risk of major in-hospital bleeding (21 vs. 10%, p<0.01), but similar decreases in the adjusted odds of one-year mortality (OR 0.62, 95% CI 0.47–0.81), which were independent of hematocrit levels.
Conclusions Patients with hematocrit levels below 27% had decreased odds of cardiac catheterization during NSTEMI compared to those without anemia. Although revascularization was associated with a higher risk for bleeding during hospitalization in patients with versus those without anemia, the decreases in the risk of 1-year mortality associated with revascularization were independent of anemia status.