Coronary artery diseaseImpact of Anemia on Clinical Outcomes of Patients With ST-Segment Elevation Myocardial Infarction in Relation to Gender and Adjunctive Antithrombotic Therapy (from the HORIZONS-AMI Trial)
Section snippets
Methods
The HORIZONS-AMI protocol, inclusion and exclusion criteria, and principal results have been reported in detail elsewhere.5 Briefly, 3,602 patients aged ≥18 years who had persistent ST-segment elevation ≥1 mm in ≥2 contiguous leads, new left bundle branch block, or true posterior infarctions and symptoms consistent with acute myocardial infarctions lasting >20 minutes but <12 hours who underwent primary PCI were randomized 1:1 to treatment with bivalirudin alone (Angiomax; The Medicines
Results
Patient flow and follow-up appear in Figure 1. Among a total of 3,602 patients in the HORIZONS-AMI trial, baseline hematocrit before angiography was available in 3,389 patients (94.1%), including 2,603 men (76.8%) and 786 women (23.2%). Primary PCI was attempted in a total of 3,153 of these patients (93.0%), including 2,441 of the men (77.4%) and 712 of the women (22.6%), who thus constituted the study population. From this group, anemia at baseline was present in 331 patients (10.5%),
Discussion
The main findings of the present analysis are that (1) the presence of baseline anemia was strongly associated with increased 30-day and 1-year mortality, but this relation was gender specific, with mortality independently related to anemia in men but not in women; (2) baseline anemia was a strong independent predictor of major bleeding regardless of gender; and (3) treatment with bivalirudin significantly reduced rates of all-cause and cardiac mortality, major bleeding, and combined adverse
References (28)
- et al.
Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial
J Am Coll Cardiol
(2004) - et al.
Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial
Am Heart J
(2002) - et al.
The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions
J Am Coll Cardiol
(2002) - et al.
Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 trial
Am J Cardiol
(2007) - et al.
Impact of “nuisance” bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation
Am J Cardiol
(2008) - et al.
The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative
J Am Coll Cardiol
(2005) - et al.
Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia
Blood
(2004) - et al.
Effect of anemia on hemorrhagic complications and mortality following percutaneous coronary intervention
Am J Cardiol
(2007) - et al.
Blood transfusion in elderly patients with acute myocardial infarction
N Engl J Med
(2001)