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 |
|
This article has been cited by other articles:
|
|
|
|
 
B. J. Doyle, C. S. Rihal, D. A. Gastineau, and D. R. Holmes Jr
Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention implications for contemporary practice.
J. Am. Coll. Cardiol.,
June 2, 2009;
53(22):
2019 - 2027.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Anker, A. Voors, D. Okonko, A. L. Clark, M. K. James, S. von Haehling, J. Kjekshus, P. Ponikowski, K. Dickstein, and for the OPTIMAAL Investigators
Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial
Eur. Heart J.,
June 1, 2009;
30(11):
1331 - 1339.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Shishehbor, S. Madhwal, V. Rajagopal, A. Hsu, P. Kelly, H. S. Gurm, S. R. Kapadia, M. S. Lauer, and E. J. Topol
Impact of Blood Transfusion on Short- and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction
J. Am. Coll. Cardiol. Intv.,
January 1, 2009;
2(1):
46 - 53.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. T. Hare, A. K. Y. Tsui, A. T. McLaren, T. E. Ragoonanan, J. Yu, and C. D. Mazer
Anemia and Cerebral Outcomes: Many Questions, Fewer Answers
Anesth. Analg.,
October 1, 2008;
107(4):
1356 - 1370.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Manzano-Fernandez, F. J. Pastor, F. Marin, F. Cambronero, C. Caro, D. A. Pascual-Figal, I. P. Garrido, E. Pinar, M. Valdes, and G. Y. H. Lip
Increased Major Bleeding Complications Related to Triple Antithrombotic Therapy Usage in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Artery Stenting
Chest,
September 1, 2008;
134(3):
559 - 567.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Manzano-Fernandez, F. Marin, J. A. H. Martinez, F. Cambronero, M. Valdes, J. M. Ruiz-Nodar, P. Perez-Berbel, and G. Y.H. Lip
Anaemia as predictor of gastrointestinal bleeding in atrial fibrillation patients undergoing percutaneous coronary artery stenting
QJM,
September 1, 2008;
101(9):
749 - 751.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Henriksen, K. Palmer, and N. A. Boon
Management of upper gastrointestinal haemorrhage complicating dual anti-platelet therapy
QJM,
April 1, 2008;
101(4):
261 - 267.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al.
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Eur. Heart J.,
July 1, 2007;
28(13):
1598 - 1660.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Aronson, M. Suleiman, Y. Agmon, A. Suleiman, M. Blich, M. Kapeliovich, R. Beyar, W. Markiewicz, and H. Hammerman
Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction
Eur. Heart J.,
June 1, 2007;
28(11):
1289 - 1296.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Bindra, C. Berry, J. Rogers, N. Stewart, M. Watts, J. Christie, S.M. Cobbe, and H. Eteiba
Abnormal haemoglobin levels in acute coronary syndromes.
QJM,
December 1, 2006;
99(12):
851 - 862.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Valeur, O. W. Nielsen, J. J.V. McMurray, C. Torp-Pedersen, L. Kober, and TRACE Study Group
Anaemia is an independent predictor of mortality in patients with left ventricular systolic dysfunction following acute myocardial infarction
Eur J Heart Fail,
October 1, 2006;
8(6):
577 - 584.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. W. O'Neill
Risk of bleeding after elective percutaneous coronary intervention.
N. Engl. J. Med.,
September 7, 2006;
355(10):
1058 - 1060.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kleinbongard, R. Schulz, T. Rassaf, T. Lauer, A. Dejam, T. Jax, I. Kumara, P. Gharini, S. Kabanova, B. Ozuyaman, et al.
Red blood cells express a functional endothelial nitric oxide synthase
Blood,
April 1, 2006;
107(7):
2943 - 2951.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Witt, R. D. Brown Jr., S. J. Jacobsen, S. A. Weston, B. P. Yawn, and V. L. Roger
A Community-Based Study of Stroke Incidence after Myocardial Infarction
Ann Intern Med,
December 6, 2005;
143(11):
785 - 792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
X. Yang, K. P. Alexander, A. Y. Chen, M. T. Roe, R. G. Brindis, S. V. Rao, W. B. Gibler, E. M. Ohman, E. D. Peterson, and for the CRUSADE Investigators
The Implications of Blood Transfusions for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: Results From the CRUSADE National Quality Improvement Initiative
J. Am. Coll. Cardiol.,
October 18, 2005;
46(8):
1490 - 1495.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Halkin, M. Singh, E. Nikolsky, C. L. Grines, J. E. Tcheng, E. Garcia, D. A. Cox, M. Turco, T. D. Stuckey, Y. Na, et al.
Prediction of Mortality After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: The CADILLAC Risk Score
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1397 - 1405.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Sabatine, D. A. Morrow, R. P. Giugliano, P. B.J. Burton, S. A. Murphy, C. H. McCabe, C. M. Gibson, and E. Braunwald
Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes
Circulation,
April 26, 2005;
111(16):
2042 - 2049.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. W. O'Neill, S. R. Dixon, and C. L. Grines
The year in interventional cardiology
J. Am. Coll. Cardiol.,
April 5, 2005;
45(7):
1117 - 1134.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al.
Highlights of the year in JACC 2004
J. Am. Coll. Cardiol.,
January 4, 2005;
45(1):
137 - 153.
[Full Text]
[PDF]
|
|
|
|
