Coronary Artery Disease
Prognostic Impact of Age and Hemoglobin in Acute ST-Segment Elevation Myocardial Infarction Treated With Reperfusion Therapy

https://doi.org/10.1016/j.amjcard.2017.03.018Get rights and content

Advanced age and low hemoglobin levels have been associated with a poor prognosis in ST-segment elevation myocardial infarction (STEMI). We studied 1,111 patients with STEMI who received reperfusion treatment (1,032 [92.9%] primary angioplasty and 79 [7.1%] fibrinolysis without rescue percutaneous coronary intervention). Mean age was 64.1 ± 14.0 years, and 23.2% were women. Patients in the last age quartile (>76 years) were more frequently women, presented more risk factors (except smoking), received thrombolysis less frequently, had less complete revascularization, and presented more complications and higher mortality. Hemoglobin level at admission was associated with age and ranged from 14.8 ± 1.5 g/dl in the first quartile to 13.2 ± 1.8 g/dl in the last, p <0.001. Multivariate analysis identified age as a predictor of in-hospital and long-term mortality (odds ratio 1.04, 95% confidence interval [CI] 1.00 to 1.07, hazard ratio 1.06, 95% CI 1.04 to 1.08). Hemoglobin levels were associated with better survival (odds ratio 0.8, 95% CI 0.6 to 0.9, hazard ratio 0.85, 95% CI 0.78 to 0.92). The other predictors of inhospital mortality were Killip class, chronic kidney disease, left ventricular ejection fraction, significant pericardial effusion, and ventricular arrhythmias. The association of hemoglobin with hospital mortality was seen in men and in women ≥65 years. In men ≥65 years, this association was also present in those with hemoglobin levels in the normal range. In conclusion, in patients with STEMI, hemoglobin is an independent predictor of inhospital and long-term mortality, especially in those aged ≥65 years. This association is also present in men ≥65 years with normal hemoglobin levels.

Section snippets

Methods

Our data come from the DIAMANTE (Descripción del Infarto Agudo de Miocardio: Actuaciones, Novedades, Terapias y Evolución—Description of Acute Myocardial Infarction: Management, New Therapies and Evolution) registry.14, 15 This database includes prospectively collected consecutive patients with STEMI admitted to the Coronary Intensive Care Unit of the Gregorio Marañón University Hospital (Madrid, Spain), a primary percutaneous coronary intervention (PCI)–capable tertiary center offering service

Results

A total of 1,111 patients were included; 1,032 (92.9%) received primary angioplasty (including 41 patients with rescue PCI) and 79 thrombolytic therapy [7.1%] without rescue PCI. The mean age was 64.1 ± 14.0 years, and 258 were women (23.2%). The proportion of women and the prevalence of risk factors increased with age, except in the case of tobacco consumption where the opposite was seen (Table 1). Age was also associated with lower hemoglobin level at admission and a higher rate of hospital

Discussion

Our study confirms the higher risk profile of older patients with STEMI. Our main finding is the association of hemoglobin with prognosis, also present in patients with normal hemoglobin levels, particularly in older patients. This is important as hemoglobin levels decrease with age.21

In DIAMANTE at hospital admission, 15% of all patients had anemia. Anemia has been reported to be present in 15% to 30% of patients with acute myocardial infarction,10, 22 but this rate can go as high as 43% in

Disclosures

The authors have no conflicts of interest to disclose.

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