The development of anemia of inflammation during acute myocardial infarction
Introduction
There are multiple lines of evidence to suggest that the presence of anemia in patients with acute myocardial infarction (AMI) is detrimental [1], [2], [3], [4], [5]. Although several authors suggest that bleeding episodes during invasive procedures and intensive anticoagulation contribute to the development of anemia [6], [7], anemia develops in nearly half of AMI hospitalizations among patients treated medically or with percutaneous coronary intervention, commonly in the absence of documented bleeding, and is associated with worse mortality and health status [8]. Thus, better understanding of how anemia can be prevented and whether its prevention can improve patient outcomes is needed.
The inflammatory response is an integral component of the reaction to tissue injury in patients with acute myocardial infarction (AMI) and persists for several weeks [9]. It has been shown that inflammation and acute phase response interact with the hematopoietic system at several levels resulting in reduced erythropoieses, accelerated destruction of erythrocytes and erythropoietin resistance [10], [11], [12]. We have presently explored the possibility that at least part of the anemia in patients with AMI is related to the presence of an inflammatory response, as well as the possibility that the timing from symptom onset till the time of angiographic intervention is related to the appearance of both an inflammatory response and a concomitant state of anemia.
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Study population
We have presently analyzed data which was collected in the time period of March 1, 2006 to February 3, 2010, at the catheterization laboratory of the department of cardiology at the Tel-Aviv Sourasky medical center, Tel-Aviv, Israel. Informed consent was obtained from each patient as approved by the institutional ethics committee. Patients were recruited during their participation in the Tel-Aviv Angiogrpahy Prospective Study (TAPAS) [13]. The diagnosis of unstable angina pectoris (UAP) and AMI
Results
We have presently analyzed the data of 1017 ACS patients presenting with UAP (340) and AMI (677). The baseline characteristics and relevant medications used by these patients are reported in Table 1. It can be seen that the UAP patients had more co-morbidities, whereas the AMI group were treated more aggressively with anti-thrombotics. As a group, the mean baseline hemoglobin level did not differ between AMI and UAP patients. Acute myocardial patients had increased levels of both CRP and
Discussion
In the present study we have shown that the time from onset of precordial pain to coronary angiography in patients with AMI is associated with the appearance of an acute phase response and a drop of hemoglobin concentration. We raise therefore the possibility that the anemia seen in patients with AMI could be, at least in part, an anemia of inflammation.
This possibility has been thought up previously. In 665 chronic dialysis patients with AMI, Nissenson et al. [20] have shown that
Acknowledgments
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [30].
Grant support: none.
References (30)
- et al.
Effect of anemia in high-risk groups of patients with acute myocardial infarction treated with percutaneous coronary intervention
Am J Cardiol
(2010) - et al.
Impact 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)
Am J Cardiol
(2010) - et al.
Prevalence and prognostic significance of transient, persistent, and new-onset anemia after acute myocardial infarction
Am J Cardiol
(2009) - et al.
An acute inflammatory reaction induced by myocardial damage is superimposed on a chronic inflammation in unstable coronary artery disease
Am Heart J
(2005) - et al.
Regulation of iron homeostasis in anemia of chronic disease and iron deficiency anemia: diagnostic and therapeutic implications
Blood
(2009) - et al.
Comparison of values of wide-range C-reactive protein to high-sensitivity C-reactive protein in patients undergoing coronary angiography
Am J Cardiol
(2007) - et al.
Universal definition of myocardial infarction
J Am Coll Cardiol
(2007) - et al.
Iron status in the acute phase and six weeks after myocardial infarction
Free Radic Biol Med
(1990) - et al.
Biomarkers of premature atherosclerosis
Trends Mol Med
(2009) - et al.
The clinical significance of hematocrit values before and after percutaneous coronary intervention
Am Heart J
(2009)
Ethical authorship and publishing
Int J Cardiol
Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial
Eur Heart J
Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction
Eur Heart J
Relations between bleeding and outcomes in patients with ST-elevation myocardial infarction in the ExTRACT-TIMI 25 trial
Eur Heart J
Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes
Eur Heart J
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