Outcomes of anemic patients presenting with acute coronary syndrome: An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events

Ronald Huynh, Karice Hyun, Mario D'Souza, Nadarajah Kangaharan, Pratap C. Shetty, Justin Mariani, Jens Kilian, Joseph Hung, Mark Ryan, Derek Chew, David Brieger

Research output: Contribution to journalArticle

Abstract

Background: Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia. Results: A total of 1880 (21.7%) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P <.0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs 33%, P <.0001) or primary percutaneous coronary intervention (PCI) (45% vs 51% P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63% vs 86%, P <.0001); drug eluting stents if undergoing PCI (50% vs 58%, P <.0001); dual antiplatelet therapy (80% vs 89%, P <.0001)and parenteral anticoagulants (82% vs 88%, P <.0001). In hospital complications of heart failure (20% vs 9%, P <.0001), renal failure (13% vs 4%, P <.0001), and re-infarction (4% vs 2%, P =.0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality. Conclusions: Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes.

LanguageEnglish
Pages791-796
Number of pages6
JournalClinical Cardiology
Volume42
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • acute coronary syndrome
  • anemia
  • anticoagulation
  • antiplatelets
  • percutaneous intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Huynh, Ronald ; Hyun, Karice ; D'Souza, Mario ; Kangaharan, Nadarajah ; Shetty, Pratap C. ; Mariani, Justin ; Kilian, Jens ; Hung, Joseph ; Ryan, Mark ; Chew, Derek ; Brieger, David. / Outcomes of anemic patients presenting with acute coronary syndrome : An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events. In: Clinical Cardiology. 2019 ; Vol. 42, No. 9. pp. 791-796.
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abstract = "Background: Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia. Results: A total of 1880 (21.7{\%}) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P <.0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22{\%} vs 33{\%}, P <.0001) or primary percutaneous coronary intervention (PCI) (45{\%} vs 51{\%} P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63{\%} vs 86{\%}, P <.0001); drug eluting stents if undergoing PCI (50{\%} vs 58{\%}, P <.0001); dual antiplatelet therapy (80{\%} vs 89{\%}, P <.0001)and parenteral anticoagulants (82{\%} vs 88{\%}, P <.0001). In hospital complications of heart failure (20{\%} vs 9{\%}, P <.0001), renal failure (13{\%} vs 4{\%}, P <.0001), and re-infarction (4{\%} vs 2{\%}, P =.0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality. Conclusions: Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes.",
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Outcomes of anemic patients presenting with acute coronary syndrome : An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events. / Huynh, Ronald; Hyun, Karice; D'Souza, Mario; Kangaharan, Nadarajah; Shetty, Pratap C.; Mariani, Justin; Kilian, Jens; Hung, Joseph; Ryan, Mark; Chew, Derek; Brieger, David.

In: Clinical Cardiology, Vol. 42, No. 9, 01.09.2019, p. 791-796.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of anemic patients presenting with acute coronary syndrome

T2 - Clinical Cardiology

AU - Huynh, Ronald

AU - Hyun, Karice

AU - D'Souza, Mario

AU - Kangaharan, Nadarajah

AU - Shetty, Pratap C.

AU - Mariani, Justin

AU - Kilian, Jens

AU - Hung, Joseph

AU - Ryan, Mark

AU - Chew, Derek

AU - Brieger, David

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N2 - Background: Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia. Results: A total of 1880 (21.7%) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P <.0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs 33%, P <.0001) or primary percutaneous coronary intervention (PCI) (45% vs 51% P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63% vs 86%, P <.0001); drug eluting stents if undergoing PCI (50% vs 58%, P <.0001); dual antiplatelet therapy (80% vs 89%, P <.0001)and parenteral anticoagulants (82% vs 88%, P <.0001). In hospital complications of heart failure (20% vs 9%, P <.0001), renal failure (13% vs 4%, P <.0001), and re-infarction (4% vs 2%, P =.0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality. Conclusions: Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes.

AB - Background: Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia. Results: A total of 1880 (21.7%) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P <.0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs 33%, P <.0001) or primary percutaneous coronary intervention (PCI) (45% vs 51% P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63% vs 86%, P <.0001); drug eluting stents if undergoing PCI (50% vs 58%, P <.0001); dual antiplatelet therapy (80% vs 89%, P <.0001)and parenteral anticoagulants (82% vs 88%, P <.0001). In hospital complications of heart failure (20% vs 9%, P <.0001), renal failure (13% vs 4%, P <.0001), and re-infarction (4% vs 2%, P =.0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality. Conclusions: Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes.

KW - acute coronary syndrome

KW - anemia

KW - anticoagulation

KW - antiplatelets

KW - percutaneous intervention

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