Six-month mortality and cardiac catheterization in non-ST-segment elevation myocardial infarction patients with
Wen-Chih Wu1, Molly E Waring, Darleen Lessard
1Research Enhancement Award Program, Providence, Massachusetts, USA.
Insights
Anemia in non-ST-segment elevation myocardial infarction (NSTEMI) patients reduces cardiac catheterization use and its survival benefit. Cardiac catheterization only lowered mortality in patients without anemia.
Area of Science:
- Cardiology
- Hematology
Background:
- Anemia's impact on invasive management and mortality in non-ST-segment elevation myocardial infarction (NSTEMI) is unclear.
- Investigating the relationship between cardiac catheterization and 6-month mortality in NSTEMI patients with varying anemia severity.
Purpose of the Study:
- To determine if anemia influences the utilization of cardiac catheterization in NSTEMI patients.
- To assess the association between cardiac catheterization and 6-month mortality across different anemia severity levels in NSTEMI patients.
Main Methods:
- Utilized data from the Worcester Heart Attack Study (2634 NSTEMI patients, 1997-2005).
- Categorized anemia severity by admission hematocrit: moderate-to-severe (≤30.0%), mild (30.1-39.0%), and no anemia (>39.0%).
- Employed propensity matching and logistic regression to compare 6-month mortality rates concerning cardiac catheterization.
Main Results:
- Anemia patients were less likely to receive cardiac catheterization (mild anemia AOR 0.79; moderate-to-severe anemia AOR 0.45).
- Cardiac catheterization was linked to reduced 6-month mortality only in patients without anemia (AOR 0.26).
- No significant mortality benefit from cardiac catheterization was observed in mild anemia patients (AOR 0.55); data for moderate-to-severe anemia was inconclusive.
Conclusions:
- Anemia in NSTEMI patients is associated with decreased cardiac catheterization rates.
- Cardiac catheterization provides a survival benefit at 6 months post-admission solely for NSTEMI patients without anemia.
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, U.S.A.) 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.
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