In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Anemia increases mortality in acute coronary syndromes (ACS). Mechanical circulatory devices (MCS) are known to cause anemia due to mechanical shearing, but there is limited data evaluating the prognostic significance of anemia in ACS patients treated with MCS. Methods: A single center retrospective cohort study included 210 consecutive ACS (56% STEMI) patients treated with MCS (IABP in 73%, 27% micro-axial pump Impella®) based on the clinical need. Clinical characteristics, hospital course details, and outcomes were obtained from the electronic health records. Results: The study cohort included 76% males, 66.9±10.9 years old, with atrial fibrillation (AF) in 9%, HTN in 43%, CHF in 37%, CAD in 42%, CABG in 40%, diabetes in 24%, COPD in 8%, and stroke in 6%. Average MCS duration was 4.0±2.8 days, with vascular complications in 17%, bleeding in 42%, transfusion in 40%, and kidney replacement therapy (KRT) in 15%. All-cause mortality was 16.2% with mean time to death of 11.2±1.2 days. There were no differences in pre-MCS Hgb between expired patients and survivors (12.3±2.6 vs. 12.8±2.2 g/dL, p=0.197). Post-MCS 24-hour Hgb was significantly lower in the expired patients (10.4+/-2.4 vs. 11.7+/-2.3, p=0.003) and in patients with prior CAD (11.1+/-2.1 vs. 11.8+/-2.5, p=0.037), while sex, AF, HTN, CABG, DM, COPD, or stroke did not affect Hgb. Admission shock (HR 4.7, 95%CI 2.087-10.783, p 〈 0.001) and KRT (HR 5.4, 95%CI 2.331-12.667, p 〈 0.001) decreased survival, while higher 24-hour Hgb (HR=0.74, 95% CI: 0.61-0.90, p=0.002) and higher presentation GFR (HR 0.968, 95%CI 0.948-0.989, p=0.003) improved survival. Transfusion did not affect mortality (18% vs. 15% in non-transfused patients, p=0.549). In a multivariate analysis, admission shock (HR 2.9, 95%CI 1.192-7.059) and KRT post MCS (HR 3.876, 95%CI 1.574-9.546, p=0.003) remained predictive of reduced survival, while Hgb and GFR were not important. Conclusion: Acute anemia in ACS patients treated with MCS is not prognostically significant. It remains unclear whether there is an optimal hemoglobin level which could alter the prognosis. Ongoing trials (MINT) are evaluating the optimal strategy of managing anemia in AMI.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.9777
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
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