Objectives: To investigate characteristics, management and outcomes of patients with acute ACS and anemia referred to coronary angiography compared to conservative medical management.
Background: Anemia in acute coronary syndrome (ACS) patients has been associated with increased risk for bleeding, ischemic events and mortality. Coronary angiography has been advocated in moderate and high risk ACS patient to optimize therapeutic decisions. However, the role of coronary angiography has not been well established in anemic ACS patients.
Methods: from a total of 5600 patients with ACS pulled from three large nationwide registries in Israel, we retrospectively reviewed and linked 1464 (26.1%) consecutive patients, who were anemic on admission, to performance of in-hospital coronary angiography (1,122 patients; 76.6%) or deferral from it (342 patients; 23.4%). We evaluated patient characteristics, in-hospital management and determined outcomes.
Results: Anemic ACS patients deferred from coronary angiography were older, suffered from higher prevalence of comorbidities and had worst cardiovascular risk profile on admission. During their hospitalization and afterwards they were less treated with current guidelines recommended medications. While they exhibited higher incidence of in-hospital complications, their in-hospital major bleeding rate was comparable to that of patients who did undergo diagnostic coronary angiography (3.8% vs. 3.1% respectively, p=0.54). Anemic patients not undergoing diagnostic coronary road-mapping exhibited increased rates of both 30-day mortality (15.6% vs. 5.7%, p<0.0001) and 12-month mortality (34.1% vs. 11.9%, p<0.0001). After multiple adjustment, for potential confounding clinical factors, performance of in-hospital coronary angiography was associated with approximately a three-fold decrease in 30-day mortality (HR 0.32, 95% CI 0.18-0.55, p<0.0001) and 12-month mortality (HR 0.37, 95% CI 0.26-0.53, p<0.0001).
Conclusions: in anemic ACS patients coronary angiography can be safely performed and might be associated with improved clinical outcomes.
