Abstract 13819: In-hospital Outcomes of Anemic Patients Presenting with Non-ST Elevation Myocardial Infarction and Undergoing an Invasive Strategy.
Objective: Randomized trials that addressed the benefit of an invasive strategy in non-ST-segment elevation myocardial infarction (NSTEMI) excluded patients with anemia. The aim of our study was to evaluate the characteristics and outcomes of anemic patients presenting with NSTEMI and managed with an invasive strategy.
Methods: We examined data of 73,067 NSTEMI from 354 sites managed with an invasive strategy between January 2007 and September 2009 who were captured by the ACTION Registry-GWTG. Patients were divided based on initial hemoglobin (Hb) into 3 groups: 1) severe anemia Hb <10 g/dl, 2) mild anemia Hb 10–12 g/dl, 3) normal Hb>12 g/dl. Outcomes were compared after adjusting for baseline clinical and demographic variables.
Results: Patients managed invasively with severe anemia had more co-morbidities, more prior myocardial infarction (33.5% vs. 24.5%), prior revascularization (44% vs.32.5%), and 3-vessel coronary artery disease (CAD) (46.2% vs. 33.9%, all p<0.0001) compared to those without anemia. Anemic patients also received fewer antithrombotic therapies and less often underwent percutaneous coronary interventions and had higher rates of red blood cell transfusion overall and prior to catheterization. In addition, they had more major bleeding, heart failure and in-hospital mortality (Table). After adjustment, severe and mild anemia were associated with increased in-hospital death (OR [95% CI]=1.3 [1.1–1.6] and 1.3 [1.1, 1.5], respectively) and heart failure (1.5 [1.3–1.7] and 1.5 [1.4–1.6], respectively) as compared to normal Hb.
Conclusion Anemic patients with NSTEMI undergoing cardiac catheterization have higher rates of transfusion overall and before catheterization and are more likely to be medically managed after catheterization. Anemia is a powerful mediator of treatment and adverse short-term outcomes.
- © 2010 by American Heart Association, Inc.