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Prognostic value of anemia at hospital admission in patients with ST-elevation myocardial infarction
Session:
Painel 6 - Doença Coronária 13
Speaker:
Ricardo Costa
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ricardo Costa; Marta Fontes Oliveira; André Dias De Frias; Andreia Campinas; André Luz; Mário Silva Santos; Severo Torres
Abstract
<p><strong>Introduction: </strong>Hemoglobin (Hb) levels are an important outcome predictor in several diseases. We aimed to evaluate Hb at hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) as a predictor of in-hospital complications, as well as mortality and heart failure (HF) events during follow-up.</p> <p><strong>Methods: </strong>We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention between 1<sup>st</sup> January 2010 and 31<sup>st</sup> December 2016. Clinical data was retrieved by review of patients’ clinical records. Severity of anemia was defined according World Health Organization cut-offs. </p> <p><strong>Results: </strong>Of 864 patients with mean age of 63±13 years, 646 (75%) were male. Mean Hb at hospital admission was 14±2g/dL, 682 (81%) with normal Hb, 118 (14%) with mild anemia, 45 (5%) with moderate and 2 (0.2%) with severe. Women, smokers, patients with diabetes, hypertension, previous myocardial infarction and peripheral artery disease had higher incidence of anemia at hospital admission. Individuals with anemia presented more with Killip-Kimball (KK) class ≥II. They also had higher incidence of in-hospital stroke, advanced atrioventricular block, gastrointestinal bleeding and need of transfusion. In-hospital mortality was 9%, higher patients with anemia (13% vs 7%, p=0.022). Median follow-up was 43 (26-66) months. All-cause mortality was 14%, higher in patients with anemia (27% vs 11%, p<0.001, Log rank test p<0.001). In multivariate analysis, only age (HR 1.1, 95% CI 1.0-1.1), diabetes (HR 1.9, 95% CI 1.1-3.4), left ventricular ejection fraction (LVEF) at discharge (if <50%, HR 3.4, 95% CI 1.6-7.2), and anemia at admission (HR 1.8, 95% CI 1.0-3.2) were independent predictors death during follow-up. Incidence of <em>de novo</em> HF, clinical worsening or hospitalization was 18%, higher in patients with anemia (27% vs 17%, p=0.007, Log rank test p=0.007). In multivariate analysis, only age (HR 1.1, 95% CI 1.0-1.1), KK class (in II, HR 2.1, 95% CI 1.3-3.5; if III, HR 4.0, 95% CI 1.8-8.9; if IV, HR 2.1, 95% CI 1.2-3.9), body mass index (if obese, HR 2.5, 95 CI 1.4-4.4) and LVEF at discharge (if <50%, HR 4.2, 95% CI 2.2-7.7), but not anemia at admission (p=0.633) were independent predictors HF-events.</p> <p><strong>Conclusion: </strong>In our cohort, presence of anemia at hospital admission in patients with STEMI was not only associated with in-hospital complications, but also with important outcomes during follow-up, as all-cause mortality and HF-events.</p>
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