Does admission anaemia still predict mortality six years after myocardial infarction?

BACKGROUND: Anaemia is present in 12-30% of patients with acute coronary syndromes (ACS). Many studies have shown that admission anaemia is an independent predictor of in-hospital or short-term mortality in patients with ACS. However, there is limited data on the long-term prognostic importance of anaemia in this group of patients. AIM: To establish the relation between haemoglobin concentration on admission and six-year all-cause mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. METHODS: We retrospectively studied 551 patients with the diagnosis of STEMI referred to the catheterisation laboratory of our hospital and treated with successful primary percutaneous coronary intervention. Patients were divided into two groups according to admission haemoglobin concentration (< 13 g/dL in males and < 12 g/dL in females). RESULTS: A total of 551 patients with STEMI (164 female, 30%) were included in the analysis, mean age was 63 ± 12 years. Anaemia on admission was present in 11% (n = 61) of the patients. Of the entire cohort, renal failure was present in 25% (n = 138), and diabetes in 16% (n = 88). Admission haemoglobin concentration was significantly associated with age (r = -0.2663, p < 0.05), blood pressure (systolic blood pressure [SBP]: r = 0.1940, diastolic blood pressure [DBP]: r = 0.2023, p < 0.05), glucose concentration (r = -0.1218, p < 0.05), white blood cells count (r = 0.1230, p < 0.05), cholesterol concentration (r = 0.1253,p < 0.05), estimated glomerular filtration rate (eGFR; r = 0.1819, p < 0.05), Killip-Kimball class (r = -0.1387, p < 0.05) and TIMI risk score for STEMI (r = -0.2647, p < 0.05). During follow-up, 27% (n = 130) of the patients died. The mortality rate was significantly higher in the patients with admission anaemia (47% vs. 24%, p = 0.0002). The patients with anaemia were older (p = 0.0007), had lower blood pressure (SBP: p = 0.007; DBP: p = 0.01), higher heart rate (p = 0.03), higher glycaemia concentration (p = 0.003), higher C-reactive protein concentration (p = 0.0007) and lower white blood cells count (p = 0.03). Patients with anaemia had more frequently renal failure (eGFR < 60 mL/min/1.73 m²) (p = 0.02) and a significantly higher TIMI risk score for STEMI (p = 0.01). In multivariate analysis, all-cause mortality was associated with: anaemia on admission (OR = 2.29; 95% CI 1.20-4.36; p = 0.011), low ejection fraction (OR = 2.97; 95% CI 1.78-4.96; p < 0.001) and age (OR = 1.65 [per 10 years]; 95% CI 1.34-2.03; p < 0.001). Anaemia on admission remained an independent predictor of six-year mortality. CONCLUSIONS: Admission anaemia significantly influences all-cause mortality in patients with STEMI treated invasively ina six-year follow-up and may be used for risk stratification in this population.

The significance of anaemia in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal. AIM: To evaluate the incidence of anaemia and its impact on early outcomes in patients undergoing primary PCI for STEMI. METHODS: Based on a retrospective review of the medical records of hospitalised patients we selected a study group comprising 551 consecutive patients with STEMI, including 164 females, mean age 63.4 ± 12 years, undergoing primary PCI within the first 12 hours after the onset of chest pain. Anaemia was diagnosed according to the World Health Organisation criteria based on haemoglobin (Hb) values on admission (〈 12 g/dL for females, 〈 13 g/dL for males). RESULTS: Anaemia was diagnosed in 61 (11%) patients (in 13% of females and 10% of males). The anaemic patients were older (71 vs 63 years, p 〈 0.001), had a lower body mass (70 vs 80 kg, p 〈 0.003) and a higher TIMI risk score for STEMI (5 vs 3, p 〈 0.0001). Their laboratory results showed a greater renal impairment (GFR 66.8 vs 75.8 mL/min, p 〈 0.008) and higher C-reactive protein levels (24.8 vs 14.4 mg/L, p 〈 0.001). There were no significant differences in post-infarction myocardial damage as estimated on the basis of ejection fraction and the baseline and peak CK-MB levels. During treatment, in both groups, there was a significant decrease in Hb levels from 11.9 to 11.0 g/dL in the anaemic patients (p 〈 0.0004) and from 14.3 to 13.3 g/dL in the non-anaemic patients (p 〈 0.001). While GFR did not change significantly in the anaemic patients, there was a significant increase in the non-anaemic patients from 75.8 to 80.9 mL/min (p 〈 0.001). The in-hospital mortality was low with a total of 8 (1.3%) patients dying: 5 (8.2%) in the anaemic group and 3 (0.6%) in the non-anaemic group (p 〈 0.001). The anaemic patients were also characterised by a higher incidence of cardiovascular complications (33% vs 17%, p = 0.003). In the multivariate analysis, older age, systolic blood pressure on admission and elevated white blood count were independently associated with a higher risk of death and cardiovascular complications, whereas baseline Hb level was a significant prognostic factor only in the univariate analysis. CONCLUSIONS: Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor.

Apelin: a novel marker for the patients with first ST-elevation myocardial infarction.

To date, only animal studies have been concerned with apelin involvement in acute myocardial ischemia. The aim of this study was to investigate apelin measurements in low-risk patients with first ST-elevation myocardial infarction (STEMI) and to assess if apelin may feature as a marker of left ventricular (LV) injury and prognosis. In 78 consecutive patients (mean age 67 +/- 11.5 years, 24 women) with first STEMI treated with primary percutaneous coronary intervention, plasma apelin-36 concentrations were measured twice: on admission and on the 5th day of hospitalization. Left ventricle ejection fraction (LVEF) was applied as marker of LV injury. Composite endpoint (CEP), which included death, stroke, and recurrent ischemic event, was assessed after 1 year follow-up. On the first day, median apelin-36 concentration was 2138.5 pg/ml and on the 5th day was significantly lower, 2008.3 pg/ml (P = 0.002). There were no significant differences found in apelin-36 concentrations between patients with normal and low LVEF. In both groups significant reductions were found in apelin-36 concentrations measured in 5-day intervals (P = 0.04 and P = 0.008, respectively). After a 1-year follow-up, only one patient died and 19 patients (24.3%) had reached CEP. No difference in baseline apelin-36 concentrations were found in the group of patients who reached CEP compared with those without CEP. However, in both groups concentrations significantly decreased after 5 days (P = 0.04 and P = 0.013, respectively). Apelin-36 concentrations are reduced in low risk first STEMI patients during the first days regardless of the degree of LV dysfunction and prognosis.