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CLINICAL RESEARCH

Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Analysis from the controlled abciximab and device investigation to lower late angioplasty complications (cadillac) trial

Eugenia Nikolsky, MD, PhD^*,, Eve D. Aymong, MD, FACC^*,, Amir Halkin, MD^*,, Cindy L. Grines, MD, FACC, David A. Cox, MD, FACC, Eulogio Garcia, MD^||, Roxana Mehran, MD, FACC^*,, James E. Tcheng, MD, FACC^¶, John J. Griffin, MD, FACC^#, Giulio Guagliumi, MD^**, Thomas Stuckey, MD, FACC, Mark Turco, MD, FACC, David A. Cohen, MD, FACC, Manuela Negoita, MD^*,, Alexandra J. Lansky, MD, FACC^*, and Gregg W. Stone, MD, FACC^*,,*

^* Cardiovascular Research Foundation, New York, New YorkUSA
Lenox Hill Heart and Vascular Institute, New York, New YorkUSA
William Beaumont Hospital, Royal Oak, MichiganUSA
Mid Carolina Cardiology, Charlotte, North CarolinaUSA
^|| Hospital Gregorio Maranon, Madrid, Spain
^¶ Duke Clinical Research Institute, Durham, North CarolinaUSA
^# Virginia Beach General Hospital, Virginia Beach, VirginiaUSA
^** Ospedali Riuniti di Bergamo, Bergamo, Italy
Moses Cone Memorial Hospital, Greensboro, North CarolinaUSA
Washington Adventist Hospital, Tacoma Park, MarylandUSA
Beth Israel Hospital, Boston, MassachusettsUSA

Manuscript received January 12, 2004; revised manuscript received February 24, 2004, accepted March 11, 2004.

^* Reprint requests and correspondence: Dr. Gregg W. Stone, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022 (Email: gstone{at}crf.org).

OBJECTIVES: We sought to investigate the impact of anemia in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI).

BACKGROUND: The prognostic importance of anemia on primary PCI outcomes is unknown.

METHODS: In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 2,082 patients of any age with AMI within 12 h onset undergoing primary PCI were randomized to balloon angioplasty versus stenting, each ± abciximab. Outcomes were stratified by the presence of anemia at baseline, as defined by World Health Organization criteria (hematocrit <39% for men and <36% for women).

RESULTS: Anemia was present in 260 (12.8%) of 2,027 randomized patients with baseline laboratory values. Patients with versus without baseline anemia more frequently developed in-hospital hemorrhagic complications (6.2% vs. 2.4%, p = 0.002), had higher rates of blood product transfusions (13.1% vs. 3.1%, p < 0.0001), and had a prolonged (median 4.1 vs. 3.5 days, p < 0.0001) and more expensive (median costs $12,434 vs. $11,603, p = 0.002) index hospitalization. Patients with versus without anemia had strikingly higher mortality during hospitalization (4.6% vs. 1.1%, p = 0.0003), at 30 days (5.8% vs. 1.5%, p < 0.0001), and at 1 year (9.4% vs. 3.5%, p < 0.0001). The rates of disabling stroke at 30 days (0.8% vs. 0.1%, p = 0.005) and at 1 year (2.1% vs. 0.4%, p = 0.0007) were also significantly higher in patients with anemia. By multivariate analysis, anemia was an independent predictor of in-hospital mortality (hazard ratio, 3.26; p = 0.048) and one-year mortality (hazard ratio, 2.38; p = 0.016).

CONCLUSIONS: Anemia at baseline in patients with AMI undergoing primary PCI is common, and is strongly associated with adverse outcomes and increased mortality.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CADILLAC = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications trial   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction   TVR = target vessel revascularization   WHO = World Health Organization

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