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Riley RF, Newby LK, Don CW, et al. Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR. Eur Heart J Acute Cardiovasc Care. 2013;2(1):35-43doi: 10.1177/2048872612471216.
Riley, R. F., Newby, L. K., Don, C. W., Alexander, K. P., Peterson, E. D., Peng, S. A., Gandhi, S. K., Kutcher, M. A., Amsterdam, E. A., & Herrington, D. M. (2013). Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR. European heart journal. Acute cardiovascular care, 2(1), 35-43. https://doi.org/10.1177/2048872612471216
Riley, Robert F, et al. "Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR." European heart journal. Acute cardiovascular care vol. 2,1 (2013): 35-43. doi: https://doi.org/10.1177/2048872612471216
Riley RF, Newby LK, Don CW, Alexander KP, Peterson ED, Peng SA, Gandhi SK, Kutcher MA, Amsterdam EA, Herrington DM. Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR. Eur Heart J Acute Cardiovasc Care. 2013 Mar;2(1):35-43. doi: 10.1177/2048872612471216. PMID: 24062932; PMCID: PMC3760583.
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Eur Heart J Acute Cardiovasc Care. 2013 Mar;2(1):35-43. doi: 10.1177/2048872612471216.

Guidelines-based treatment of anaemic STEMI patients: practice patterns and effects on in-hospital mortality: a retrospective analysis from the NCDR.

European heart journal. Acute cardiovascular care

Robert F Riley, L Kristin Newby, Creighton W Don, Karen P Alexander, Eric D Peterson, S Andrew Peng, Sanjay K Gandhi, Michael A Kutcher, Ezra A Amsterdam, David M Herrington

Affiliations

  1. Wake Forest University Health Sciences, Winston-Salem, USA.

PMID: 24062932 PMCID: PMC3760583 DOI: 10.1177/2048872612471216

Abstract

BACKGROUND: Anaemia is associated with an increased risk for morbidity and mortality in ST-elevation myocardial infarction (STEMI) patients. While several physiological mechanisms have been proposed to explain this association, decreased receipt of guidelines-based care may also contribute. We examined the relationship between admission haemoglobin (Hgb) level, receipt of ACC/AHA guidelines-based treatments, and in-hospital outcomes among STEMI patients. We also evaluated whether administration of these treatments modified the association between anaemia and in-hospital mortality in this group.

METHODS AND RESULTS: We analysed data from 92,686 patients diagnosed with STEMI included in the NCDR ACTION Registry-GWTG database from January 2007 to March 2011. Patients were stratified by initial Hgb value: 83.1% (n=77,035) were classified as non-anaemic (Hgb >13.0 g/dl for men, >12.0 g/dl for women), 11.6% (n=10,710) as mildly anaemic (11.1-13.0 g/dl for men, 11.1-12.0 g/dl for women), 4.4% (n=4059) as moderately anaemic (9.1-11.0 g/dl), and 1.0% (n=882) as severely anaemic (<9.0 g/dl). Anaemia was associated with a significantly increased prevalence of other baseline comorbidities and decreased odds of receiving several class I recommended pharmacological treatments (heparin, beta-blockers, and angiotensin-converting enzyme inhibitors, p<0.01). The overall use of reperfusion therapy (fibrinolytic therapy and/or percutaneous coronary intervention) was also lower in anaemic vs. non-anaemic patients (p<0.01). Anaemia was associated higher in-hospital mortality risk, which remained significant after adjustment for use of guidelines-recommended therapies and interventions (p<0.01).

CONCLUSIONS: In a national sample of STEMI patients, anaemia on presentation was associated with decreased receipt of ACC/AHA guidelines-based care and higher in-hospital mortality. However, the higher mortality rates could not be fully explained by differences in in-hospital treatment.

Keywords: Anaemia; ST-segment myocardial infarction (STEMI); guidelines; outcomes; treatment

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