Am J Med. 2023 Sep 11:S0002-9343(23)00543-0. doi: 10.1016/j.amjmed.2023.08.012. Online ahead of print.
BACKGROUND: Anemia (either pre-existing or hospital-acquired) is considered an independent predictor of mortality in acute coronary syndromes. However, it is still not clear whether anemia should be considered as a marker of worse health status or a therapeutic target. We sought to investigate the relationship between hospital-acquired anemia and clinical and laboratory findings and to assess the association with mortality and major cardiovascular events (MACE) at long term follow-up.
METHODS: Patients consecutively admitted at Niguarda Hospital between February 2014 and November 2020 for an acute coronary syndrome were included in this cohort analysis and classified as anemic at admission (group A), with normal hemoglobin (Hb) at admission but developing anemia during hospitalization (hospital-acquired anemia) (group B); and with normal Hb levels throughout admission (group C).
RESULTS: Among 1294 patients included, group A included 353 (27%) patients, group B 468 (36%) and group C 473 patients (37%). In terms of cardiovascular burden and incidence of death, MACE and bleeding at 4.9-year median follow-up, group B had an intermediate risk profile as compared to A and C. Baseline anemia was an independent predictor of death (HR=1.51, 95% CI:1.02-2.25, p=0.04) along with frailty, Charlson comorbidity Index, eGFR, previous myocardial infarction and left ventricular ejection fraction. Conversely, hospital-acquired anemia was not associated with increased mortality (HR=1.18,95% CI:0.8-1.75, p=0.4).
CONCLUSIONS: Hospital-acquired anemia affects one third of patients hospitalized for an acute coronary syndromes and is associated with age, frailty and comorbidity burden, but was not found to be an independent predictor of long-term mortality.