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
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