SPC365

Effect of severe anemia (hemoglobin < 10g/dL) on short- and long-term outcome in acute coronary syndrome: insights of a terciary centre

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Isabel Campos

Congress: CPC 2021
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: Isabel Durães Campos; Cátia Oliveira; Carla Marques Pires; Paulo Medeiros; Rui Flores; Fernando Mané; Rodrigo Silva; Carlos Galvão Braga; Catarina Vieira; Jorge Marques

<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:#000000"><span style="background-color:white"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Although invasive strategies are the generalized approach in the management of acute coronary syndrome (ACS) pts, their benefits in pts with significant anemia are unclear, as anemia is strongly associated with increased risk of morbidity and mortality.</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:#000000"><span style="background-color:white"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">AIM:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> To determine the incidence and the impact of severe anemia (hemoglobin < 10g/dL) on short- and long-term outcome in pts hospitalized with acute coronary syndrome.</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:#000000"><span style="background-color:white"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">METHODS:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> We analysed retrospectively 2905 ACS pts admitted for 6 years in our coronary care unit. Pts were divided into two groups: group 1 - pts with severe anemia (hemoglobin < 10g/dL) (n=257, 8.8%); group 2 - pts without severe anemia (hemoglobin 10g/dL) (n=2648, 91.2%). Primary endpoint was the occurrence of a composite of deathand adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 6 months; follow-up was completed in 96% pts. </span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:#000000"><span style="background-color:white"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">RESULTS:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">  The sample consisted in 2262 (77.9%) men and 643 (22.1%) women, with mean age of 64±13 years. The incidence of severe anemia was 8.8%. Group 1 pts were older (74±11 vs 63±13, p<0.001), had a higher proportion of women (47.9% vs 19.6%,p<0.001), diabetes (45.5% vs 26.1%, p<0.001), hypertension (81.7% vs 61.5%, p<0.001), chronic kidney disease (24.0% vs 2.8%, p<0.001) and atrial fibrillation (8.9% vs 5.0%, p <0.001). During hospitalization, group 1 had more heart failure (71.2% vs 24.2%, p<0.001), angor (12.1% vs 4.6%, p<0.001), refarction (5.1% vs 2.0%, p=0.006), worst LVEF (53.9% vs 32%, p<0,001), bleeding (6.1%% vs 0.3%, p <0.001) and transfusion (20% vs 0%, p <0.001). Group 1 had a higher proportion of NSTEMI pts (56.0% vs 47.3%, p=0.009) as opposed to group 2 which had more STEMI (40.1% vs 47.2%, p=0.031). During hospitalization, group 2 pts were more likely to undergo revascularization (71.7% vs 83.7%, p<0.001) and double antiaggregation (85.2% vs 93.7%, p<0.001). A multivariate analysis identified age [OR 1.06, 95%CI 1.04 to 1.07; p<0.001] and feminine sex [OR 2.61, 95%CI 1.89 to 3.61; p<0.001] as independent predictors of severe anemia during hospitalization. Patients with severe anemia had longer hospital stay (11 ± 9 days vs 6 ± 4 days; p<0.001), and higher 6-month mortality (32.1% vs. 6.9%; p<0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and adverse cardiovascular events at 6months compared to those without severe anemia [OR 5.04, 95%CI 1.21 to 21.04; p=0.026].</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14pt"><span style="font-family:"Courier New""><span style="color:#000000"><span style="background-color:white"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">CONCLUSION:</span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. However, pts with severe anemia who were double antiaggregated had no worse outcomes than those who had simple antiaggregation after 6months. Therefore, there was no significant difference regarding revascularization in these pts.</span></span></span></span></span></span></span></p>