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J Am Coll Cardiol, 2004; 44:547-553, doi:10.1016/j.jacc.2004.03.080 © 2004 by the American College of Cardiology Foundation |














,*
* 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.
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