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Six-month mortality and cardiac catheterization in non-ST-segment elevation myocardial infarction patients with anemia

Wu, Wen-Chiha,b; Waring, Molly E.c; Lessard, Darleenc; Yarzebski, Jorgec; Gore, Joeld; Goldberg, Robert J.c

doi: 10.1097/MCA.0b013e3283471fb1
Pathophysiology and Natural History

Background It is unknown how anemia influences the invasive management of patients with non-ST-segment elevation myocardial infarction (NSTEMI) and associated mortality. We investigated whether receipt of cardiac catheterization relates to 6-month death rates among patients with different severity of anemia.

Methods We used data from the population-based Worcester Heart Attack Study, which included 2634 patients hospitalized with confirmed NSTEMI, from three percutaneous coronary intervention-capable medical centers in the Worcester (Massachusetts, USA) metropolitan area, during five biennial periods between 1997 and 2005. Severity of anemia was categorized using admission hematocrit levels: less than or equal to 30.0% (moderate-to-severe anemia), 30.1–39.0% (mild anemia), and more than 39.0% (no anemia). Propensity matching and conditional logistic regression adjusting for hospital use of aspirin, heparin, and plavix compared 6-month postadmission all-cause mortality rates in relation to cardiac catheterization during NSTEMI hospitalization.

Results Compared with patients without anemia, patients with anemia were less likely to undergo cardiac catheterization {adjusted odds ratio (AOR) 0.79 [95% confidence interval (CI): 0.67–0.95] for mild anemia and 0.45 (95% CI: 0.42–0.49) for moderate-to-severe anemia}. After propensity matching, cardiac catheterization was associated with lower 6-month death rates only in patients without anemia [AOR 0.26 (95% CI: 0.09–0.79)] but not in patients with mild anemia [AOR 0.55 (95% CI: 0.25–1.23)]. The small number of patients rendered data inconclusive for patients with moderate-to-severe anemia.

Conclusion Anemia at the time of hospitalization for NSTEMI was associated with lower utilization of cardiac catheterization. However, cardiac catheterization use was associated with a decreased risk of dying at 6 months after hospital admission only in patients without anemia.

aResearch Enhancement Award Program and the Medical Service, Providence Veterans Affairs Medical Center

bDepartment of Medicine and Community Health, Warren Alpert Medical School, Brown University

cand Departments of Quantitative Health Sciences

dMedicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Correspondence to Robert J. Goldberg, PhD, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, 377 Plantation Street, Suite 305, Worcester, MA 01655, USA Tel: +1 508 856 3991; fax: +1 508 856 4596; e-mail: Robert.Goldberg@umassmed.edu

This study was made possible by the cooperation of the medical records, administration, and cardiology departments of participating hospitals in the Worcester metropolitan area. The views expressed in this study are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Parts of this study were presented as a poster in the 2009 National American Heart Association meeting in Orlando, Florida, USA.

Received January 24, 2011

Accepted March 24, 2011

© 2011 Lippincott Williams & Wilkins, Inc.