Faculty Collaboration Database

Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction undergoing an invasive strategy according to hemoglobin levels. Am J Cardiol 2013 Apr 15;111(8):1099-103

Date

03/05/2013

Pubmed ID

23453458

DOI

10.1016/j.amjcard.2012.12.041

Scopus ID

2-s2.0-84875866897 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

The benefit of an invasive strategy in non-ST-segment elevation myocardial infarction (NSTEMI) was established from randomized trials that included few anemic patients. The aim of this study was to describe the characteristics, therapies, and mortality of patients with NSTEMIs who undergo an invasive strategy in relation to their admission hemoglobin levels. Data from 73,067 patients with NSTEMIs who underwent cardiac catheterization and who were captured by the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION-GWTG) were examined. Patients were divided into 3 hemoglobin groups on the basis of initial hemoglobin level: (1) <10 g/dl, (2) 10 to 12 g/dl, or (3) >12 g/dl. Patients with hemoglobin <10 g/dl had more co-morbidities and more 3-vessel coronary artery disease at catheterization compared with those with hemoglobin >12 g/dl (46.2% vs 33.9%, all p values <0.0001). They received fewer acute antithrombotic therapies, less often underwent revascularization (57.4% vs 74.1%), and had higher rates of red blood cell transfusion before catheterization (32.1% vs 0.3%, all p values <0.0001). After adjustment, in-hospital mortality was inversely associated with initial hemoglobin, with a 7% increase for each 1 g/dl decrease in hemoglobin lower than 15 g/dl (odds ratio 1.07, 95% confidence interval 1.02 to 1.11). In conclusion, in patients presenting with NSTEMIs and managed with an invasive strategy, a lower hemoglobin level is associated with more extensive coronary artery disease, less use of revascularization and evidence-based therapies, and increased mortality.

Author List

Hanna EB, Alexander KP, Chen AY, Roe MT, Funk M, Saucedo JF

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Cardiac Catheterization
Chi-Square Distribution
Cohort Studies
Comorbidity
Coronary Angiography
Female
Hemoglobins
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction
Registries
Risk Factors
Statistics, Nonparametric
United States