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Jhand AS, Abusnina W, Tak HJ, Ahmed A, Ismayl M, Altin SE, Sherwood MW, Alexander JH, Rao SV, Abbott JD, Carson JL, Goldsweig AM. Impact of anemia on outcomes and resource utilization in patients with myocardial infarction: A national database analysis. Int J Cardiol 2024; 408:132111. [PMID: 38697401 DOI: 10.1016/j.ijcard.2024.132111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Although anemia is common in patients with myocardial infarction (MI), management remains controversial. We quantified the association of anemia with in-hospital outcomes and resource utilization in patients admitted with MI using a large national database. METHODS All hospitalizations with a primary diagnosis code for acute MI in the National Inpatient Sample (NIS) between 2014 and 2018 were identified. Among these hospitalizations, patients with anemia were identified using a secondary diagnosis code. Data on demographic and clinical variables were collected. Outcomes of interest included in-hospital adverse events, length of stay (LOS), and total cost. Multivariable logistic regression and generalized linear models were used to evaluate the relationship between anemia and outcomes. RESULTS Among 1,113,181 MI hospitalizations, 254,816 (22.8%) included concomitant anemia. Anemic patients were older and more likely to be women. After adjustment for demographics and comorbidities, anemia was associated with higher mortality (7.1 vs. 4.3%; odds ratio 1.09; 95% confidence interval [CI] 1.07-1.12, p < 0.001). Anemia was also associated with a mean of 2.71 days longer LOS (average marginal effects [AME] 2.71; 95% CI 2.68-2.73, p < 0.05), and $ 9703 mean higher total costs (AME $9703, 95% CI $9577-$9829, p < 0.05). Anemic patients who received blood transfusions had higher mortality as compared with those who did not (8.2% vs. 7.0, p < 0.001). CONCLUSION In MI patients, anemia was associated with higher in-hospital mortality, adverse events, total cost, and length of stay. Transfusion was associated with increased mortality, and its role in MI requires further research.
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Affiliation(s)
- Aravdeep S Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Waiel Abusnina
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Arslan Ahmed
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Matthew W Sherwood
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, NC, USA; Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - John H Alexander
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, NC, USA
| | - Sunil V Rao
- Division of Cardiology, New York University Langone Health System, New York, NY, USA
| | - J Dawn Abbott
- Division of Cardiology, Brown University and Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Jeffrey L Carson
- Department of Internal Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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Zhu Z, Zhou X. Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction. Acta Cardiol 2024; 79:179-186. [PMID: 38085221 DOI: 10.1080/00015385.2023.2289718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 04/18/2024]
Abstract
BACKGROUND The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. METHODS This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. RESULTS During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. CONCLUSION Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.
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Affiliation(s)
- Zhulin Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tirandi A, Schiavetta E, Maioli E, Montecucco F, Liberale L. Inflammation as a cause of acute myocardial infarction in patients with myeloproliferative neoplasm. World J Cardiol 2024; 16:58-63. [PMID: 38456066 PMCID: PMC10915890 DOI: 10.4330/wjc.v16.i2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Myeloproliferative neoplasms (MPN) are a group of diseases characterized by the clonal proliferation of hematopoietic progenitor or stem cells. They are clinically classifiable into four main diseases: chronic myeloid leukemia, essential thrombocythemia, polycythemia vera, and primary myelofibrosis. These pathologies are closely related to cardio- and cerebrovascular diseases due to the increased risk of arterial thrombosis, the most common underlying cause of acute myocardial infarction. Recent evidence shows that the classical Virchow triad (hypercoagulability, blood stasis, endothelial injury) might offer an explanation for such association. Indeed, patients with MPN might have a higher number and more reactive circulating platelets and leukocytes, a tendency toward blood stasis because of a high number of circulating red blood cells, endothelial injury or overactivation as a consequence of sustained inflammation caused by the neoplastic clonal cell. These abnormal cancer cells, especially when associated with the JAK2V617F mutation, tend to proliferate and secrete several inflammatory cytokines. This sustains a pro-inflammatory state throughout the body. The direct consequence is the induction of a pro-thrombotic state that acts as a determinant in favoring both venous and arterial thrombus formation. Clinically, MPN patients need to be carefully evaluated to be treated not only with cytoreductive treatments but also with cardiovascular protective strategies.
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Affiliation(s)
- Amedeo Tirandi
- Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
| | - Elisa Schiavetta
- Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
| | - Elia Maioli
- Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa 16132, Italy.
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa 16132, Italy
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Risk stratification based on components of the complete blood count in patients with acute coronary syndrome: A classification and regression tree analysis. Sci Rep 2018; 8:2838. [PMID: 29434357 PMCID: PMC5809451 DOI: 10.1038/s41598-018-21139-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 12/02/2022] Open
Abstract
To develop a risk stratification model based on complete blood count (CBC) components in patients with acute coronary syndrome (ACS) using a classification and regression tree (CART) method. CBC variables and the Global Registry of Acute Coronary Events (GRACE) scores were determined in 2,693 patients with ACS. The CART analysis was performed to classify patients into different homogeneous risk groups and to determine predictors for major adverse cardiovascular events (MACEs) at 1-year follow-up. The CART algorithm identified the white blood cell count, hemoglobin, and mean platelet volume levels as the best combination to predict MACE risk. Patients were stratified into three categories with MACE rates ranging from 3.0% to 29.8%. Kaplan-Meier analysis demonstrated MACE risk increased with the ascending order of the CART risk categories. Multivariate Cox regression analysis showed that the CART risk categories independently predicted MACE risk. The predictive accuracy of the CART risk categories was tested by measuring discrimination and graphically assessing the calibration. Furthermore, the combined use of the CART risk categories and GRACE scores yielded a more accurate predictive value for MACEs. Patients with ACS can be readily stratified into distinct prognostic categories using the CART risk stratification tool on the basis of CBC components.
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Liu CW, Liao PC, Chen KC, Hsu JC, Li AH, Tu CM, Wu YW. Baseline Hemoglobin Levels Associated with One-Year Mortality in ST-Segment Elevation Myocardial Infarction Patients. ACTA CARDIOLOGICA SINICA 2016; 32:656-666. [PMID: 27899852 DOI: 10.6515/acs20160106a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The association between hemoglobin (Hb) levels and mortality in patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. The purpose of this study was to examine the mortality among STEMI patients with anemia or erythrocytosis, and further establish the relationship between mortality and the increment of Hb level. METHODS Between 2006 and 2012, 951 consecutive patients with STEMI undergoing primary percutaneous coronary intervention in a medical center in Northern Taiwan were enrolled in our study, including 535 patients with normal Hb level, 148 with anemia (male Hb ≤ 13 g/dl, female ≤ 12) and 268 with erythrocytosis (male Hb ≥ 16, female ≥ 15). RESULTS Patients in the anemia group were the oldest, and had higher morbidity than the normal Hb group, followed by the erythrocytosis group. In regression analyses, neither anemia nor erythrocytosis was associated with 30-day and 1-year mortality. Each 1-g/dl increment of Hb level was not associated with 30-day mortality both in patients with anemia or erythrocytosis. However, it was associated with a decreased risk of 1-year mortality in anemic patients [hazard ratio (HR): 0.756, 95% confidence interval (CI): 0.608-0.938, p = 0.011] and an increased risk of 1-year mortality in those with erythrocytosis (HR: 2.086, 95%CI: 1.106-3.937, p = 0.023). In multivariate analysis, each 1-g/dl increment of Hb level was associated with 1-year mortality both in anemic patients and those with erythrocytosis (HR: 0.788, 95%CI: 0.621-0.999, p = 0.049; HR: 2.302, 95%CI: 1.051-5.04, p = 0.037). CONCLUSIONS Higher hemoglobin levels in STEMI patients with anemia were associated with decreased risks of 1-year mortality, whereas higher hemoglobin levels in those with erythrocytosis were associated with increased risks of one-year mortality.
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Affiliation(s)
- Cheng-Wei Liu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; ; Department of Internal Medicine, Tri-Service General Hospital, Songshan Branch; ; National Defense Medical Center
| | - Pen-Chih Liao
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Kuo-Chin Chen
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Jung-Cheng Hsu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; ; Chihlee Institute of Technology
| | - Ai-Hsien Li
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Chung-Ming Tu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; ; Chihlee Institute of Technology
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City; ; Departments of Internal Medicine; ; Departments of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ; Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City; ; National Yang-Ming University School of Medicine, Taipei, Taiwan
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6
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Mamas MA, Kwok CS, Kontopantelis E, Fryer AA, Buchan I, Bachmann MO, Zaman MJ, Myint PK. Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry. J Am Heart Assoc 2016; 5:e003348. [PMID: 27866164 PMCID: PMC5210321 DOI: 10.1161/jaha.116.003348] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aim to determine the prevalence of anemia in acute coronary syndrome (ACS) patients and compare their clinical characteristics, management, and clinical outcomes to those without anemia in an unselected national ACS cohort. METHODS AND RESULTS The Myocardial Ischemia National Audit Project (MINAP) registry collects data on all adults admitted to hospital trusts in England and Wales with diagnosis of an ACS. We conducted a retrospective cohort study by analyzing patients in this registry between January 2006 and December 2010 and followed them up until August 2011. Multiple logistic regressions were used to determine factors associated with anemia and the adjusted odds of 30-day mortality with 1 g/dL incremental hemoglobin increase and the 30-day and 1-year mortality for anemic compared to nonanemic groups. Analyses were adjusted for covariates. Our analysis of 422 855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic and that these patients are older, have a greater prevalence of renal disease, peripheral vascular disease, diabetes mellitus, and previous acute myocardial infarction, and are less likely to receive evidence-based therapies shown to improve clinical outcomes. Finally, our analysis suggests that anemia is independently associated with 30-day (OR 1.28, 95% CI 1.22-1.35) and 1-year mortality (OR 1.31, 95% CI 1.27-1.35), and we observed a reverse J-shaped relationship between hemoglobin levels and mortality outcomes. CONCLUSIONS The prevalence of anemia in a contemporary national ACS cohort is clinically significant. Patients with anemia are older and multimorbid and less likely to receive evidence-based therapies shown to improve clinical outcomes, with the presence of anemia independently associated with mortality outcomes.
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Affiliation(s)
- Mamas A Mamas
- Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
- Farr Institute, University of Manchester, United Kingdom
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
| | | | - Anthony A Fryer
- Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
- Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
| | - Iain Buchan
- Farr Institute, University of Manchester, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Norwich Research Park Cardiovascular Research Group, Norwich, United Kingdom
| | - M Justin Zaman
- Norwich Research Park Cardiovascular Research Group, Norwich, United Kingdom
- Department of Medicine, James Paget University Hospital, Gorleston, United Kingdom
| | - Phyo K Myint
- Norwich Research Park Cardiovascular Research Group, Norwich, United Kingdom
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom
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Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. White blood cell, hemoglobin and platelet distribution width as short-term prognostic markers in patients with acute myocardial infarction. J Korean Med Sci 2014; 29:519-26. [PMID: 24753699 PMCID: PMC3991795 DOI: 10.3346/jkms.2014.29.4.519] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/11/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to assess the prognostic value of combined use of white blood cell (WBC), hemoglobin (Hb), and platelet distribution width (PDW) in patients with acute myocardial infarction (AMI). This study included 1,332 consecutive patients with AMI. Patients were categorized into complete blood cell (CBC) group 0 (n=346, 26.0%), 1 (n=622, 46.7%), 2 (n=324, 24.3%), and 3 (n=40, 3.0%) according to the sum of the value defined by the cut-off levels of WBC (1, ≥ 14.5 × 10(3)/µL; 0, <14.5 × 10(3)/µL), Hb (1, <12.7 g/dL; 0, ≥ 12.7 g/dL), and PDW (1, ≥ 51.2%; 0: <51.2%). In-hospital death occurred in 59 (4.4%) patients. Patients who died during index hospitalization had higher WBC and PDW and lower Hb. The patients could be stratified for in-hospital mortality according to CBC group; 1.2%, 2.7%, 9.0%, and 22.5% in CBC groups 0, 1, 2, and 3 (P<0.001), respectively. In multivariate logistic regression analysis, CBC group ≥ 2 (odds ratio, 3.604; 95% confidence interval, 1.040-14.484, P=0.043) was an independent predictor for in-hospital death. The prognostic impact of the combined use of CBC markers remained significant over 12 months. In conclusions, combination of WBC, Hb, and PDW, a cheap and simple hematologic marker, is useful in early risk stratification of patients with AMI.
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Affiliation(s)
- Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry). ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:212-20. [PMID: 24570721 PMCID: PMC3915993 DOI: 10.5114/pwki.2013.37498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/26/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management. Aim To elaborate a composite risk management concept for STEMI, enhancing clinical decision making. Material and methods 1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified. Results In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group. Conclusions The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.
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Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: a systematic review. Eur J Vasc Endovasc Surg 2014; 47:422-32. [PMID: 24485842 DOI: 10.1016/j.ejvs.2013.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/19/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Peripheral arterial disease (PAD) is principally caused by atherosclerosis, an established inflammatory disease. Total white cell count (TWCC) is a marker of inflammation and has been associated with outcomes for patients with inflammatory diseases. The aim of this systematic review was to assess the association of TWCC with mortality and major adverse events (MAEs) in PAD patients. METHODS Studies investigating the association of TWCC with outcome in patients with PAD were identified by a literature search using the Medline and Cochrane databases. To be eligible for inclusion, studies needed to investigate the association of TWCC with mortality or a composite endpoint that included mortality in patients with PAD. Studies were excluded when the primary focus was carotid artery disease, aortic aneurysmal disease, intracranial vascular disease, or rheumatoid arthritis and treatment with chemotherapy or transplantation of stem cells. Secondary searching of reference lists and relevant reviews was performed. RESULTS Ten studies including 8,490 patients with PAD met the inclusion criteria. All studies investigated more than 100 patients with four studies assessing more than 1,000 patients. Study quality varied with well-established risk factors of outcome such as age, smoking, diabetes, and the ankle brachial index being adjusted for inconsistently. The study populations were also disparate. Few studies reported relative risk and 95% confidence intervals for the association of TWCC with mortality or MAE. TWCC was positively and significantly associated with death alone in four of five studies investigating 3,387 patients. TWCC was positively and significantly associated with MAE in five of six studies investigating a total of 6,846 patients. CONCLUSIONS Current evidence suggests a positive association of TWCC with mortality and MAEs in patients with PAD. Further well-designed prospective studies are required with high-quality analysis and more complete reporting of outcomes.
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Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J 2013; 165:143-53.e5. [PMID: 23351816 DOI: 10.1016/j.ahj.2012.10.024] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/04/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anemia is a common comorbidity among patients with acute coronary syndromes (ACS) and may adversely affect cardiovascular outcomes in these patients. We conducted a systematic review and meta-analysis to examine the association between anemia and mortality among patients with ACS. METHODS We systematically searched MEDLINE to identify cohort studies and secondary analyses of randomized controlled trials examining the association between anemia and all-cause mortality among patients with ACS. Data were aggregated at 4 follow-up times (inhospital, 30 days, 1 year, and maximal available follow-up) using random-effects meta-analysis models. RESULTS Twenty-seven studies met the inclusion criteria, involving 233,144 patients. Anemia was present in 44,519 (19.1%) of these patients. Anemic patients were generally older and had a higher prevalence of comorbidities including diabetes mellitus, congestive heart failure, cerebrovascular disease, and history of major bleeding. Anemia was associated with an increased risk of crude all-cause mortality (relative risk 2.08, 95% CI 1.70-2.55) and reinfarction (relative risk 1.25, 95% CI 1.02-1.53) at maximal available follow-up. When adjusted risk ratios from individual studies' multivariable regression analyses were pooled, the magnitude of the associated mortality risk was attenuated but remained significant at maximal follow-up (hazard ratio 1.49, 95% CI 1.23-1.81). Clinically and statistically significant increases in mortality were observed as early as at 30 days post-ACS and persisted at 1 year. CONCLUSIONS Anemia in patients with ACS is independently associated with a significantly increased risk of early and late mortality.
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Liu Y, Yang YM, Zhu J, Tan HQ, Liang Y, Li JD. Anaemia and prognosis in acute coronary syndromes: a systematic review and meta-analysis. J Int Med Res 2012; 40:43-55. [PMID: 22429344 DOI: 10.1177/147323001204000105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This meta-analysis was conducted to summarize the association between anaemia and outcomes in patients with acute coronary syndromes (ACS). METHODS MEDLINE®, Cochrane Library, OVID and EMBASE databases were searched to identify studies that examined the effect of anaemia on mortality or other adverse events (heart failure, cardiogenic shock or major bleeding). RESULTS Nineteen studies met the final inclusion criteria (total number of patients 241 293). The risks of shortterm mortality (odds ratio [OR] 2.77; 95% confidence interval [CI] 2.09, 3.65), long-term mortality (OR 2.03; 95% CI 1.52, 2.71), heart failure (OR 1.96; 95% CI 1.47, 2.62), cardiogenic shock (OR 1.95; 95% CI 1.04, 2.64) and major bleeding (OR 4.28; 95% CI 1.05, 17.14) were increased in patients with anaemia, compared with patients without anaemia. Anaemia was also associated with a higher risk of mortality (adjusted hazard ratio 1.49, 95% CI 1.24, 1.79). CONCLUSIONS These study findings suggest that anaemia can be used to identify patients with ACS who are at a high risk of death or adverse events, and it may become a promising risk stratification factor in ACS.
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Affiliation(s)
- Y Liu
- Emergency Centre of Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Honda T, Kanazawa H, Koga H, Miyao Y, Fujimoto K. Heart rate on admission is an independent risk factor for poor cardiac function and in-hospital death after acute myocardial infarction. J Cardiol 2010; 56:197-203. [DOI: 10.1016/j.jjcc.2010.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 12/19/2022]
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Clustering of admission hyperglycemia, impaired renal function and anemia and its impact on in-hospital outcomes in patients with ST-elevation myocardial infarction. Atherosclerosis 2010; 209:558-64. [DOI: 10.1016/j.atherosclerosis.2009.09.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 01/08/2023]
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Ino Y, Kubo T, Tomobuchi Y, Oshika H, Kitabata H, Obana M, Tanimoto T, Takarada S, Tanaka A, Imanishi T, Okamura Y, Akasaka T. Branch Segment Occlusion With Acute Myocardial Infarction is a Risk for Left Ventricular Free Wall Rupture. Circ J 2009; 73:1473-8. [DOI: 10.1253/circj.cj-08-1112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Hiroyuki Oshika
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Masahiro Obana
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Shigeho Takarada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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