Impact of anemia as risk factor for major bleeding and mortality in patients with acute coronary syndrome

Autor: Luna Carrillo-Alemán, Mariano Valdés, María Asunción Esteve-Pastor, Esteban Orenes-Piñero, Miriam Sandín-Rollán, Juan M. Ruiz-Nodar, Teresa Lozano, Elena Candela-Sánchez, Manuel Jesús Macías-Villaniego, Vicente Pernias-Escrig, Nuria Vicente-Ibarra, Elena Guzmán, Laura Nuñez‐Martínez, Francisco Marín, José Miguel Rivera-Caravaca
Rok vydání: 2019
Předmět:
Male
Acute coronary syndrome
medicine.medical_specialty
Anemia
medicine.medical_treatment
Hemorrhage
030204 cardiovascular system & hematology
Acute coronary syndrome
Anemia
Hemorrhage
Ischemia
Mortality
Platelet aggregation inhibitors
03 medical and health sciences
Hemoglobins
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Ischemia
Internal medicine
Platelet aggregation inhibitors
hemic and lymphatic diseases
Internal Medicine
medicine
Humans
030212 general & internal medicine
Prospective Studies
Registries
Risk factor
Acute Coronary Syndrome
Mortality
Cardiac catheterization
Aged
Proportional Hazards Models
Aged
80 and over
business.industry
Middle Aged
medicine.disease
Clopidogrel
Spain
Cohort
Multivariate Analysis
Platelet aggregation inhibitor
Observational study
Female
business
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: EUROPEAN JOURNAL OF INTERNAL MEDICINE
r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname
r-FISABIO: Repositorio Institucional de Producción Científica
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
r-FISABIO. Repositorio Institucional de Producción Científica
ISSN: 0953-6205
Popis: Background: Anemia is frequent in acute coronary syndrome (ACS) patients and is associated with worse clinical outcomes. We aimed to investigate the therapeutic strategies, the use of novel P2Y(12) inhibitors, and the prognostic implication of anemia in a "real world" cohort of ACS patients. Methods: This is an observational and prospective registry including 1717 ACS patients from three tertiary hospitals. During hospitalization we recorded the clinical management and the antiplatelet therapy at discharge. Patients were divided into 2 groups according to the baseline hemoglobin level, i.e. anemic (hemoglobin < 13 g/dL in men and < 12 g/dL in women) and non-anemic patients. Bleeding events, mortality and major adverse cardiovascular events (MACEs) were recorded during 1-year of follow-up. Results: Anemia was present in 445 (25.9%) patients. Cardiac catheterization (83.8% vs. 94.5%, p < .001), and revascularization by percutaneous coronary intervention (53.5% vs. 70.5%, p < .001) were less frequent in these patients. Excluding anticoagulated patients, novel P2Y(12) inhibitors were less prescribed in anemic patients (OR 2.80 [95% CI 2.13-3.67], p < .001). Anemia was independently associated with major bleeding (HR 2.26 [95% CI 1.07-4.78], p = .033) and all-cause mortality (HR 1.62 [95% CI 1.03-2.56], p = .038), but not with MACE. At 1-year of follow-up, the risk of mortality in anemic patients taking clopidogrel was higher (HR 2.38 [95% CI 1.01-5.67]; p = .049). Conclusions: In this registry involving ACS patients, anemia had influence on clinical management and antiplatelet therapy. Patients suffering from anemia had higher risk for major bleeding and mortality. In particular, anemic patients treated with clopidogrel had even more mortality events.
Databáze: OpenAIRE
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