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Li P, Chen M, Huang Y, Wang R, Chi J, Hu J, Huang J, Wu N, Cai H, Yuan H, Li M, Xu L. Prognostic impact of in-hospital hemoglobin decline in non-overt bleeding ICU patients with acute myocardial infarction. BMC Cardiovasc Disord 2023; 23:231. [PMID: 37138214 PMCID: PMC10158222 DOI: 10.1186/s12872-023-03251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The prognostic value of in-hospital hemoglobin drop in non-overt bleeding patients with acute myocardial infarction (AMI) admitted to the intensive care unit (ICU) remains insufficiently investigated. METHODS A retrospective analysis was performed based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. 2,334 ICU-admitted non-overt bleeders diagnosed with AMI were included. In-hospital hemoglobin values (baseline value on admission and nadir value during hospitalization) were available. Hemoglobin drop was defined as a positive difference between admission and in-hospital nadir hemoglobin. The primary endpoint was 180-day all-cause mortality. The time-dependent Cox proportional hazard models were structured to analyze the connection between hemoglobin drop and mortality. RESULTS 2,063 patients (88.39%) experienced hemoglobin drop during hospitalization. We categorized patients based on the degree of hemoglobin drop: no hemoglobin drop (n = 271), minimal hemoglobin drop (< 3 g/dl; n = 1661), minor hemoglobin drop (≥ 3 g/dl & < 5 g/dl, n = 284) and major hemoglobin drop (≥ 5 g/dl; n = 118). Minor (adjusted hazard ratio [HR] = 12.68; 95% confidence interval [CI]: 5.13-31.33; P < 0.001) and major (adjusted HR = 13.87; 95% CI: 4.50-42.76; P < 0.001) hemoglobin drops were independently associated with increased 180-day mortality. After adjusting the baseline hemoglobin level, a robust nonlinear relationship was observed in the association between hemoglobin drop and 180-day mortality, with 1.34 g/dl as the lowest value (HR = 1.04; 95% CI: 1.00-1.08). CONCLUSION In non-overt bleeding ICU-admitted patients with AMI, in-hospital hemoglobin drop is independently associated with higher 180-day all-cause mortality.
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Affiliation(s)
- Pengfei Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Meixiang Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yuekang Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Ruixin Wang
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - JiaNing Chi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jiaman Hu
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jianyu Huang
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Ningxia Wu
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Hua Cai
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Hui Yuan
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Min Li
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Lin Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Geriatric Cardiology, General Hospital of Southern Theater Command, Guangzhou, China.
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, China.
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Kanic V, Kompara G, Suran D. Differential impact of anemia in relation to sex in patients with myocardial infarction. Front Cardiovasc Med 2023; 10:1108710. [PMID: 36910519 PMCID: PMC9995835 DOI: 10.3389/fcvm.2023.1108710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Data on the possible sex-specific effects of anemia on clinical outcome in patients with myocardial infarction are extremely sparse, conflicting, and inconclusive. We investigated the possible sex-specific effects of anemia on outcome in patients with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). Methods Data from 8,318 patients, who were divided into four groups: men and women with and without anemia on admission, were analyzed. The association between anemia and sex and 30-day and long-term mortality was assessed. The median follow-up time was 7 years (25th, 75th percentile: 4, 11). Results Non-anemic men had the lowest 30-day and long-term observed mortality (4.3, 18.7%), followed by non-anemic women (7.0, 25.3%; p < 0.0001, p < 0.0001). Anemic men and women had similar mortality rates (12.8, 46.2%) and (13.4, 45.6%; p = 0.70, p = 0.80), respectively. The anemia/sex groups were independently associated with 30-day and long-term mortality (p = 0.033 and p < 0.0001, respectively). Compared to non-anemic men, non-anemic and anemic women had a similar risk of death at 30 days, but anemic men had a 50% higher risk of death (OR 1.12; 95% CI 0.83-1.52; p = 0.45, OR 1.30; 95% CI 0.94-1.79; p = 0.11, OR 1.50; 95% CI 1.13-1.98; p = 0.004, respectively). In the long term, anemic men had a 46% higher, non-anemic women 15% lower, and anemic women a similar long-term mortality risk to non-anemic men (HR 1.46; 95% CI 1.31-1.63; p < 0.0001, HR 0.85; 95% CI 0.76-0.96; p = 0.011, and HR 1.06; 95% CI 0.93-1.21; p = 0.37, respectively). Conclusion Our result suggests that the influence of anemia in patients with MI is different in men and women, with anemia seemingly much more harmful in male than in female patients with MI.
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Bruno RR, Wolff G, Kelm M, Jung C. Pharmacological treatment of cardiogenic shock - A state of the art review. Pharmacol Ther 2022; 240:108230. [PMID: 35697151 DOI: 10.1016/j.pharmthera.2022.108230] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock is a clinical syndrome of impaired tissue perfusion caused by primary cardiac dysfunction and inadequate cardiac output. It represents one of the most lethal clinical conditions in intensive care medicine with mortality >40%. Management of different clinical presentations of cardiogenic shock includes guidance of cardiac preload, afterload, heart rate and contractility by differential pharmacological modulation of volume, systemic and pulmonary vascular resistance and cardiac output besides reversing the triggering cause. Data from large registries and randomized controlled trials on optimal diagnostic guidance as well as choice of pharmacological agents has accrued significantly in recent years. This state-of-the-art review summarizes the basic concepts of cardiogenic shock, the diagnostic work-up and currently available evidence and guideline recommendations on pharmacological treatment of cardiogenic shock.
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Affiliation(s)
- Raphael Romano Bruno
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Georg Wolff
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Christian Jung
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany.
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Jung C, Rezar R, Wischmann P, Masyuk M, Datz C, Bruno RR, Kelm M, Wernly B. The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses. Int J Cardiol 2022; 367:1-10. [PMID: 36055474 DOI: 10.1016/j.ijcard.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O). METHODS We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality. RESULTS Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70-2.55) and transfusion (1.93 95%CI 1.12-3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70-1-05), administration of ESA (RR 0.55 95%CI 0.22-1.33) and iron deficiency (OR 1.24 95%CI 0.12-13.13) were not associated with altered all-cause mortality. CONCLUSION Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany.
| | - Richard Rezar
- Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
| | - Patricia Wischmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Datz
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria.
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, Teaching Hospital of the Paracelsus Medical University Salzburg, General Hospital Oberndorf, Paracelsus Medical University Salzburg, Oberndorf, Austria; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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Wischmann P, Bruno RR, Wernly B, Wolff G, Afzal S, Rezar R, Cramer M, Heramvand N, Kelm M, Jung C. Relevance of pre-existing anaemia for patients admitted for acute coronary syndrome to an intensive care unit: a retrospective cohort analysis of 7418 patients. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac040. [PMID: 35919579 PMCID: PMC9260305 DOI: 10.1093/ehjopen/oeac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
Aims Patients with acute coronary syndrome (ACS) frequently suffer from anaemia, but its role in patients admitted to an intensive care unit (ICU) is unclear. This analysis evaluates the prognostic relevance of different degrees of anaemia and their specific impact on disease severity and the outcome in critically ill ACS patients. Methods and results and results The multi-centre electronic Intensive Care Unit Collaborative Research Database was used, and all patients admitted with ACS were included in a retrospective analysis. Anaemia and its degrees were defined according to the criteria by the World Health Organization. A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of hospital mortality. A total of 7418 patients were included; 3437 patients (46%) had anaemia on admission. Patients with anaemia were significantly older [61 (53–70) vs. 70 (61–78) years, P < 0.001], more often female (P < 0.001), and required an increased rate of vasopressor use (P < 0.001) and mechanical ventilation (P < 0.001). With the higher Sequential organ failure assessment score (1 vs. 2; P < 0.001) and Acute Physiology And Chronic Health Evaluation (35 vs. 47; P < 0.001) scores, a higher degree of anaemia was associated with prolonged ICU stay (2 vs. 5 days, P < 0.001). Even patients with mild anaemia needed significantly from more intensive treatment and suffered worse outcome. Intensive care unit and hospital mortality were inversely associated with haemoglobin levels. Conclusion Nearly half of critically ill patients with ACS suffer from anaemia, which is associated with increased illness severity, complex ICU procedures, and mortality—even in mild anaemia. Haemoglobin on admission is an independent factor for adverse outcome.
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Affiliation(s)
- Patricia Wischmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Bernhard Wernly
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University , Strubergasse 21, 5020 Salzburg , Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Mareike Cramer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Nadia Heramvand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Heinrich Heine University , Moorenstraße 5, 40225 Duesseldorf , Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
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Ndrepepa G, Neumann FJ, Menichelli M, Holdenrieder S, Richardt G, Mayer K, Cassese S, Xhepa E, Kufner S, Wiebe J, Joner M, Kessler T, Laugwitz KL, Schunkert H, Kastrati A. Prognostic value of haemoglobin drop in patients with acute coronary syndromes. Eur J Clin Invest 2021; 51:e13670. [PMID: 34541662 DOI: 10.1111/eci.13670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prognostic value of in-hospital haemoglobin drop in patients with acute coronary syndrome (ACS) undergoing invasive therapy remains insufficiently investigated. MATERIALS AND METHODS This observational study included 3838 patients with ACS with admission and in-hospital nadir haemoglobin values available. Haemoglobin drop was defined as a positive difference between admission and nadir haemoglobin values. The primary endpoint was one-year all-cause mortality. RESULTS In-hospital haemoglobin drop occurred in 3142 patients (82%). Patients were categorized into 4 groups: no haemoglobin drop (n = 696 patients), <3 g/dl haemoglobin drop (n = 2703 patients), 3 to <5 g/dl haemoglobin drop (n = 344 patients) and ≥5 g/dl haemoglobin drop (n = 95 patients). The primary endpoint occurred in 156 patients: 17 patients (2.5%) in the group with no haemoglobin drop, 81 patients (3.0%) in the group with <3g/dl haemoglobin drop, 37 patients (10.9%) in the group with 3 to <5 g/dl haemoglobin drop and 21 patients (22.2%) in the group with ≥5 g/dl haemoglobin (adjusted hazard ratio [HR] = 1.30, 95% confidence interval 1.17 to 1.45; p < .001 for one g/dl haemoglobin drop). The association of haemoglobin drop with one-year mortality remained significant after exclusion of patients with in-hospital overt bleeding (adjusted HR = 1.27 [1.11-1.46]; p < .001 for one g/dl haemoglobin drop). The lowest haemoglobin drop associated with mortality was 1.23 g/dl in all patients (HR = 1.03 [1.02-1.04]) and 1.13 g/dl in patients without overt bleeding (HR = 1.03 [1.01-1.04]). CONCLUSIONS In patients with ACS, in-hospital haemoglobin drop was associated with higher risk of one-year mortality even in the absence of overt bleeding.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | | | - Stefan Holdenrieder
- Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | | | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Karl Ludwig Laugwitz
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Medizinische Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie, Pneumologie), Klinikum rechts der Isar, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Abstract
Background: Anemia is highly prevalent in low- and middle-income countries, where prevalence of acute coronary syndrome (ACS) is also rising. Evidence indicates that baseline anemia status can prognosticate ACS. However, the Global Registry of Acute Coronary Events (GRACE) score that is popularly used all over the world does not include information on anemia. Objectives: Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS. Methods: We enrolled 200 ACS patients at the Acharya Vinoba Bhave Rural Hospital—a rural, tertiary care hospital in central India. Patients were followed for 6 months for death and major adverse cardiac event (MACE). Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI). Results: There were 31 deaths due to MACE and an additional 28 non-fatal MACE events during follow-up. Baseline hemoglobin was strongly and independently associated with both outcomes even after adjusting for a multivariable propensity score. For the outcome of death and death/MACE there was a moderate improvement in the AUC of 1% and 6%, respectively. However, for these outcomes the IDI for baseline hemoglobin was 6% (p = 0.03) and 12% (p << 0.0001), respectively, while the NRI was 0.50 (p = 0.01) and 0.78 (p << 0.0001), respectively. Conclusions: Inclusion of baseline anemia in addition to the GRACE score improves prognostication of ACS patients.
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Huynh R, Hyun K, D'Souza M, Kangaharan N, Shetty PC, Mariani J, Kilian J, Hung J, Ryan M, Chew DP, Brieger D. Outcomes of anemic patients presenting with acute coronary syndrome: An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events. Clin Cardiol 2019; 42:791-796. [PMID: 31216067 PMCID: PMC6727957 DOI: 10.1002/clc.23219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population. METHODS This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia. RESULTS A total of 1880 (21.7%) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P < .0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs 33%, P < .0001) or primary percutaneous coronary intervention (PCI) (45% vs 51% P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63% vs 86%, P < .0001); drug eluting stents if undergoing PCI (50% vs 58%, P < .0001); dual antiplatelet therapy (80% vs 89%, P < .0001) ;and parenteral anticoagulants (82% vs 88%, P < .0001). In hospital complications of heart failure (20% vs 9%, P < .0001), renal failure (13% vs 4%, P < .0001), and re-infarction (4% vs 2%, P = .0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality. CONCLUSIONS Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes.
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Affiliation(s)
- Ronald Huynh
- Department of CardiologyConcord HospitalSydneyNew South WalesAustralia
| | - Karice Hyun
- ANZAC Research InstituteUniversity of SydneySydneyNew South WalesAustralia,Westmead Applied Research Centre (WARC), Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Mario D'Souza
- Department of CardiologyConcord HospitalSydneyNew South WalesAustralia
| | | | - Pratap C. Shetty
- Department of CardiologySutherland Heart ClinicSydneyNew South WalesAustralia
| | - Justin Mariani
- Department of CardiologyAlfred HospitalMelbourneVictoriaAustralia,Department of MedicineCentral Clinical School, Monash UniversityMelbourneVictoriaAustralia
| | - Jens Kilian
- Department of CardiologyBankstown HospitalSydneyNew South WalesAustralia
| | - Joseph Hung
- Department of CardiologySir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Mark Ryan
- Department of CardiologyShoalhaven HospitalNowraNew South WalesAustralia
| | - Derek P. Chew
- Cardiac ServicesFlinders Medical CentreAdelaideSouth AustraliaAustralia
| | - David Brieger
- Department of CardiologyConcord HospitalSydneyNew South WalesAustralia
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9
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Kanic V, Kompara G, Vollrath M, Suran D, Kanic Z. Age-Specific Sex-Based Differences in Anemia in Patients with Myocardial Infarction. J Womens Health (Larchmt) 2019; 28:1004-1010. [PMID: 30632879 DOI: 10.1089/jwh.2018.7211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Data are lacking concerning possible age-specific sex-based differences in anemia in myocardial infarction (MI) patients and its association with the outcome. The aim was to assess whether these differences in anemia (on admission and at discharge) in MI patients who underwent percutaneous coronary intervention (PCI) are associated with the outcome. Methods: Data from 5579 MI patients (31.0% women) undergoing PCI at our institution were analyzed. Men and women in different age groups were compared regarding anemia and its association with the 30-day and long-term all-cause mortality. Data were analyzed using descriptive statistics. Results: Women suffered anemia more than men (37.5% vs. 26.8%; p < 0.0001). The prevalence of anemia increased rapidly with age in men but not in women. A J-shaped relationship between age and anemia was found in women. The lower the age, the greater the difference in the prevalence of anemia between the sexes. The difference in the prevalence of anemia at discharge was even more pronounced. Anemia on admission (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.10-1.76; p = 0.005) and at discharge (OR = 2.61; 95% CI = 1.98-3.44; p < 0.0001) predicted a higher 30-day mortality. Women had a better adjusted long-term prognosis (hazard ratio [HR] = 0.78; 95% CI = 0.69-0.87; p < 0.0001) for the total population. Anemia on admission (HR = 1.43; 95% CI = 1.29-1.60; p < 0.0001) and at discharge (HR = 1.96; 95% CI = 1.23-2.21; p < 0.0001) predicted a higher long-term mortality. Conclusion: Younger women with MI suffer anemia more frequently than their male peers. Anemia was associated with a worse outcome. Age-specific sex-based differences in anemia help to explain the increased sex-related mortality in MI patients undergoing PCI.
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Affiliation(s)
- Vojko Kanic
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Gregor Kompara
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | | | - David Suran
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Zlatka Kanic
- 1Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
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Kanic V, Kompara G, Vollrath M, Suran D, Kanic Z. Sex-Related Anemia Contributes to Disparities in Outcome of Patients Younger Than 60 Years with ST-Elevation Myocardial Infarction. J Womens Health (Larchmt) 2018; 27:755-760. [DOI: 10.1089/jwh.2017.6644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Vojko Kanic
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Gregor Kompara
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | | | - David Suran
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Zlatka Kanic
- Division of Internal Medicine, Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
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11
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Guenancia C, Stamboul K, Hachet O, Yameogo V, Garnier F, Gudjoncik A, Cottin Y, Lorgis L. Clinical effectiveness of the systematic use of the GRACE scoring system (in addition to clinical assessment) for ischaemic outcomes and bleeding complications in the management of NSTEMI compared with clinical assessment alone: a prospective study. Heart Vessels 2015; 31:897-906. [PMID: 26047775 DOI: 10.1007/s00380-015-0695-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/29/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED We assessed the interest of systematically using the GRACE scoring system (in addition to clinical assessment) for in- hospital outcomes and bleeding complications in the management of NSTEMI compared with clinical assessments alone. Multicentre, randomized study that included 572 consecutive NSTEMI patients, randomized 1:1, into group A: clinical stratification alone and group B: clinical+ GRACE score stratification. MAIN OUTCOME MEASURES in-hospital outcomes and bleeding complications. There was no significant difference between the two groups for baseline data or for in-hospital MACE. In multivariate analysis, only a GRACE >140 (OR: 3.5, 95 % CI: 1.8-6.6, p < 0.001) and PCI (OR: 0.55, 95 % CI: 0.3-1.0; p = 0.05) were independent predictors of in-hospital MACE. The sub-analysis of group B showed that 56 patients (20 %) were given a compliance score of 0, showing that diagnostic angiography was performed later than as recommended by the guidelines. Interestingly, 91 % had a GRACE score >140, and these patients were significantly older, and were more likely to have a history of diabetes, stroke and renal failure, together with symptoms of heart failure. After multivariate analysis, the independent predictors of a lack of compliance with guideline delays were a GRACE score >140 (OR: 9.2; CI: 4.2-20.3, p < 0.001) and secondary referral from a non-PCI cardiology department (OR: 2.7; CI: 1.4-5.2, p = 0.003). In a real-world setting of patients admitted with NSTEMI, the systematic use of the GRACE scoring system at admission in the PCI centre does not improve in-hospital outcomes and bleeding complications.
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Affiliation(s)
- Charles Guenancia
- Department of Cardiology, University Hospital, Dijon, France.
- LPPCM, INSERM U866, University of Burgundy, Dijon, France.
| | - Karim Stamboul
- Department of Cardiology, University Hospital, Dijon, France
- LPPCM, INSERM U866, University of Burgundy, Dijon, France
| | - Olivier Hachet
- Department of Cardiology, University Hospital, Dijon, France
- LPPCM, INSERM U866, University of Burgundy, Dijon, France
| | | | - Fabien Garnier
- Department of Cardiology, University Hospital, Dijon, France
| | - Aurélie Gudjoncik
- Department of Cardiology, University Hospital, Dijon, France
- LPPCM, INSERM U866, University of Burgundy, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital, Dijon, France
- LPPCM, INSERM U866, University of Burgundy, Dijon, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Dijon, France
- LPPCM, INSERM U866, University of Burgundy, Dijon, France
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12
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Mirski MA, Frank SM, Kor DJ, Vincent JL, Holmes DR. Restrictive and liberal red cell transfusion strategies in adult patients: reconciling clinical data with best practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:202. [PMID: 25939346 PMCID: PMC4419449 DOI: 10.1186/s13054-015-0912-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Red blood cell (RBC) transfusion guidelines correctly promote a general restrictive transfusion approach for anemic hospitalized patients. Such recommendations have been derived from evaluation of specific patient populations, and it is important to recognize that engaging a strict guideline approach has the potential to incur harm if the clinician fails to provide a comprehensive review of the patient’s physiological status in determining the benefit and risks of transfusion. We reviewed the data in support of a restrictive or a more liberal RBC transfusion practice, and examined the quality of the datasets and manner of their interpretation to provide better context by which a physician can make a sound decision regarding RBC transfusion therapy. Reviewed studies included PubMed-cited (1974 to 2013) prospective randomized clinical trials, prospective subset analyses of randomized studies, nonrandomized controlled trials, observational case series, consecutive and nonconsecutive case series, and review articles. Prospective randomized clinical trials were acknowledged and emphasized as the best-quality evidence. The results of the analysis support that restrictive RBC transfusion practices appear safe in the hospitalized populations studied, although patients with acute coronary syndromes, traumatic brain injury and patients at risk for brain or spinal cord ischemia were not well represented in the reviewed studies. The lack of quality data regarding the purported adverse effects of RBC transfusion at best suggests that restrictive strategies are no worse than liberal strategies under the studied protocol conditions, and RBC transfusion therapy in the majority of instances represents a marker for greater severity of illness. The conclusion is that in the majority of clinical settings a restrictive RBC transfusion strategy is cost-effective, reduces the risk of adverse events specific to transfusion, and introduces no harm. In anemic patients with ongoing hemorrhage, with risk of significant bleeding, or with concurrent ischemic brain, spinal cord, or myocardium, the optimal hemoglobin transfusion trigger remains unknown. Broad-based adherence to guideline approaches of therapy must respect the individual patient condition as interpreted by comprehensive clinical review.
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Affiliation(s)
- Marek A Mirski
- Johns Hopkins Medical Institutions, 1800 Orleans Street, Phipps 455b, Baltimore, MD, 21287, USA.
| | - Steven M Frank
- Johns Hopkins Medical Institutions, 1800 Orleans Street, Phipps 455b, Baltimore, MD, 21287, USA.
| | - Daryl J Kor
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jean-Louis Vincent
- Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070, Bruxelles, Belgium.
| | - David R Holmes
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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13
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Steinvil A, Rogowski O, Banai S, Leshem-Rubinow E, Halkin A, Keren G, Finkelstein A, Mashav N, Zuzut M, Berliner S, Arbel Y. Anemia and inflammation have an additive value in risk stratification of patients undergoing coronary interventions. J Cardiovasc Med (Hagerstown) 2015; 16:106-11. [DOI: 10.2459/jcm.0b013e32836380b4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Zhu GJ, Sun LN, Li XH, Wang NF, Wu HH, Yuan CX, Li QQ, Xu P, Ren YQ, Mao BG. Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. Heart Vessels 2014; 30:669-74. [PMID: 25260401 DOI: 10.1007/s00380-014-0564-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P < 0.05). At the end of the experiments, LV - dp/dt among three groups was significantly different, drug therapy group < ECMO group < control group. There was no difference in LV + dp/dt between drug therapy group and ECMO group. Compared with drug group, myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.
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Affiliation(s)
- Gang-jie Zhu
- Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China
| | - Li-na Sun
- Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China
| | - Xing-hai Li
- Department of Cardiac Surgery, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou City, China
| | - Ning-fu Wang
- Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China.
| | | | | | | | - Peng Xu
- Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China
| | - Ya-qi Ren
- Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China
| | - Bao-gen Mao
- Department of Cardiac Surgery, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou City, China
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15
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Lin TH, Lai WT, Kuo CT, Hwang JJ, Chiang FT, Chang SC, Chang CJ. Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome: Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry. Heart Vessels 2014; 30:441-50. [PMID: 24802367 PMCID: PMC4521085 DOI: 10.1007/s00380-014-0504-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/14/2014] [Indexed: 01/18/2023]
Abstract
In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of <60 ml/min per 1.73 m2. The primary end point is the composite of death, non-fatal myocardial infarction and non-fatal stroke at 12 months. 53 (1.88 %) and 949 (33.7 %) patients suffered from IHB and CKD, respectively. Both IHB and CKD are independently associated with increased risk of the primary end point (HR 2.04, 95 % CI 1.05–3.99, p = 0.037 and HR 2.17, 95 % CI 1.63–2.87, p < 0.01, respectively). The Kaplan–Meier curves show significantly higher event rates among those with IHB and CKD in the whole, ST-elevation and non-ST elevation populations (all p < 0.01). Patients with IHB(+)/CKD(−), IHB(−)/CKD(+) and IHB(+)/CKD(+) have 1.88-, 2.13- and 2.98-fold risk to suffer from the primary end point compared with those without IHB and CKD (p = 0.23, <0.01 and <0.01, respectively). IHB or CKD is independently associated with poor cardiovascular outcome and patients with both IHB and CKD have the worst outcome in ACS.
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Affiliation(s)
- Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan, ROC
- Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan, ROC
- Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Tai Kuo
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chen Chang
- Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medicine, Research Center for Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan
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16
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Ennezat PV, Maréchaux S, Pinçon C, Finzi J, Barrailler S, Bouabdallaoui N, Van Belle E, Montalescot G, Collet JP. Anaemia to predict outcome in patients with acute coronary syndromes. Arch Cardiovasc Dis 2013; 106:357-65. [PMID: 23806304 DOI: 10.1016/j.acvd.2013.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/13/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Owing to the heterogeneous population of patients with acute coronary syndromes (ACS), risk stratification with tools such as the GRACE risk score is recommended to guide therapeutic management and improve outcome. AIM To evaluate whether anaemia refines the value of the GRACE risk model to predict midterm outcome after an ACS. METHODS A prospective registry of 1064 ACS patients (63 ± 14 years; 73% men; 57% ST-segment elevation myocardial infarction [MI]) was studied. Anaemia was defined as haemoglobin less than 13 mg/dL in men or less than 12 mg/dL in women. The primary endpoint was 6-month death or rehospitalization for MI. RESULTS The primary endpoint was reached in 132 patients, including 68 deaths. Anaemia was associated with adverse clinical outcomes (hazard ratio 3.008, 95% confidence interval 2.137-4.234; P<0.0001) in univariate analysis and remained independently associated with outcome after adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score (hazard ratio 2.870, 95% confidence interval 1.815-4.538; P<0.0001). Anaemia provided additional prognostic information to the GRACE score as demonstrated by a systematic improvement in global model fit and discrimination (c-statistic increasing from 0.633 [0.571;0.696] to 0.697 [0.638;0.755]). Subsequently, adding anaemia to the GRACE score led to reclassification of 595 patients into different risk categories; 16.5% patients at low risk (≤ 5% risk of death or rehospitalization for MI) were upgraded to intermediate (>5-10%) or high risk (>10%); 79.5% patients at intermediate risk were reclassified as low (55%) or high risk (24%); and 45.5% patients at high risk were downgraded to intermediate risk. Overall, 174 patients were reclassified into a higher risk category (17.3%) and 421 into a lower risk category (41.9%). CONCLUSION Anaemia provides independent additional prognostic information to the GRACE score. Combining anaemia with the GRACE score refines its predictive value, which often overestimates the risk.
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Affiliation(s)
- Pierre Vladimir Ennezat
- Cardiology Intensive Care Unit, CHRU Lille and Institut Fédératif de Recherche 114, EA 2693, Université de Lille 2UDSL, France.
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17
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Yang CH, Hsieh MJ, Chen CC, Wang CY, Chang SH, Lee CH, Hsieh IC. The prognostic significance of SYNTAX score after early percutaneous transluminal coronary angioplasty for acute ST elevation myocardial infarction. Heart Lung Circ 2013; 22:341-5. [PMID: 23332234 DOI: 10.1016/j.hlc.2012.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/29/2012] [Accepted: 12/03/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION SYNergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score, which is based on the characteristics of atherosclerotic lesions and the complexity of coronary artery anatomy, is useful for choosing an intervention strategy, but its prognostic significance for acute ST elevation of myocardial infarction (STEMI) remains unknown. This study aimed to redress this issue. METHODS Our observational study included 151 consecutive patients admitted for acute STEMI who underwent primary PCI between January 1, 2008 and December 31, 2009. The primary endpoint for analysis was 30-day cardiac death. RESULTS Among the 151 patients, cardiac death occurred in 10 (7%) within 30 days. After the first month, five patients died of non-cardiac causes, but no cardiac death occurred. Multivariate analysis showed that SYNTAX score (odds ratio [OR], 13.79, 95% confidence interval [CI], 1.24-153.38; p=0.033) and a symptom onset-to-therapy time interval >4 h (OR, 11.13; 95% CI, 1.08-114.42; p=0.043) were independent risk factors for 30-day mortality. The SYNTAX score cut-off for discriminating low and high risk was 22. CONCLUSIONS SYNTAX score is an independent predictor of short-term cardiac mortality in patients with acute STEMI.
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Affiliation(s)
- Chia-Hung Yang
- Department of Second Section of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taiwan
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18
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Timóteo AT, Hamad H, Miranda F, Santos N, Oliveira JA, Ferreira ML, Ferreira RC. [Can the presence of anemia on admission improve the predictive value of the GRACE risk score for short- and medium-term mortality after acute coronary syndrome?]. Rev Port Cardiol 2012; 31:279-85. [PMID: 22440054 DOI: 10.1016/j.repc.2011.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 12/15/2011] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal.
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