Author + information
- Walid Jomaa,
- Imen Ben Ali,
- Sonia Hamdi,
- Mohamed Ali Azaiez,
- Aymen El Hraiech,
- Khaldoun Ben Hamda and
- Faouzi Maatouk
Anemia is regarded as a powerful predictor of in-hospital major events in patients presenting for acute coronary syndrome. We sought to determine clinical and prognostic correlates of anemia in patients presenting for acute ST-elevation myocardial infarction (STEMI) in our region.
A total of 1498 consecutive patients presenting to our center for STEMI between January 1998 and October 2014 were included in this retrospective registry. Patients were managed either by thrombolysis, primary percutaneous coronary intervention (pPCI) or conservative medical treatment. Anemic patients (i.e. with hemoglobin <11 g/dL) and non anemic patients were compared regarding clinical characteristics and in-hospital prognosis. Predictive factors of in-hospital death were determined.
Out of the overall population, 249 (16.6%) patients were anemic. Reperfusion strategies were comparable between the two sub-groups. Anemic patients were more likely to be elderly (23.6% vs. 13.3%, p<0.001), hypertensive (37.8% vs. 28.6%, p=0.004) and diabetic (41.4% vs. 34.5%, p=0.038). In-hospital mortality rate was significantly higher in anemic patients (22.9% vs. 5.8%, p<0.001). In univariate analysis, factors significantly associated to in-hospital death in anemic patients were a management by pPCI (38.2% vs. 18.2%, p=0.001), history of hypertension (52.6% vs. 33.3%, p=0.008), diabetes mellitus (56.1% vs. 37%, p=0.01), heart failure on-admission (49.1% vs. 17.7%, p<0.001) and renal failure on-admission (31.6% vs. 12.4%, p=0.01). In multivariate analysis, independent factors associated with in-hospital death were the absence of pPCI use (HR=2.7, 95% CI: 1.33-5.55, p=0.006), history of hypertension (HR=2.15, 95% CI:1.11-4.18, p=0.023), heart failure on admission (HR=4.04, 95% CI: 2.05-7.98, p<0.001) and renal failure on-admission (HR=2.7, 95% CI: 1.26-5.89, p=0.01).
In the present study, anemic patients presenting for STEMI have a higher in-hospital mortality rate. The absence of pPCI use, hypertension, heart failure on-admission and renal failure on-admission were independently associated to in-hospital death in this subset.