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Functional iron deficiency in acute coronary syndromes: prevalence and prognostic impact
Session:
Comunicações Orais (Sessão 18) - Doença Coronária e Cuidados Intensivos 4 - Risco e Prognóstico
Speaker:
Ana Fátima Esteves
Congress:
CPC 2022
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:
Comunicações Orais
FP Number:
---
Authors:
Ana Fátima Esteves; Sara Gonçalves; Tatiana Duarte; José Maria Farinha; António Pinheiro; Joana Ferreira; Rui Coelho; Jéni Quintal; Nuno Fonseca; Rui Caria
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Functional iron deficiency (ID) is a well-known prognostic marker in heart failure (HF), independent of the presence of anemia. However, its impact in acute coronary syndromes (ACS) is not well established. Recent studies show that ID could have prognostic value in this setting but don’t discriminate between absolute and functional ID. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To evaluate the prevalence of functional ID in patients with ACS and its prognostic impact during follow-up</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective analysis of consecutive patients admitted with ACS from January to December 2019. The population was evaluated according to basal characteristics. We divided the population in two groups: with or without functional ID (defined as transferrin saturation <20% and ferritin between 100 and 299ng/mL), which were compared according to demographic and index-hospitalization variables, co-morbidities, analytical and echocardiographic data and adverse events. We determined the predictive value of functional ID on occurrence of HF, urgent care admissions, HF and total re-hospitalizations, reinfarction, hemorrhage and death. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: We included 297 patients, mean age 65.67 (<span style="font-family:Symbol">±</span>13.5) years, 72% male. From these, 167 (56%) presented with ST-segment elevation myocardial infarction (MI), 48 (16%) with </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">a Killip class equal or above 2. Previously known HF was present in 4 (1.3%) patients; on admission, 110 (37%) had a left ventricle ejection fraction (LVEF) <50%. Functional ID was identified in 70 (24%), absolute ID in 69 (23%) and anemia in 92 (31%). Of note, 70% patients with functional ID had no anemia. During a mean follow-up of 25 (<span style="font-family:Symbol">±</span>9.2) months, 61 (21%) patients were hospitalized (7% with HF) and 52 (18%) died. There were no significant differences between the two groups in terms of basal characteristics, LVEF, NT-proBNP levels or Killip class.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In univariate analysis, patients with functional ID had a significantly higher rate of HF urgent care admissions and hospitalizations. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In multivariate analysis, the presence of functional ID was an independent predictor of HF hospitalizations during follow-up with OR 3.019, 95% CI 1.015-8.981, p-value 0.047 – see Table. There was no independent impact of functional ID regarding other adverse events. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: In this population of patients with ACS, the presence of functional ID is associated with adverse outcomes, with a higher risk of HF hospitalizations. A larger number of patients is required for more definite conclusions. </span></span></p>
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