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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Association between haemoglobin decline and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients
Fatma Esin1, Hüseyin Sefa Ince1, Gökhun Akkan2
1Department of Cardiology, Izmir Katip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey.
Insights
Significant in-hospital hemoglobin decline in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI) is linked to higher long-term mortality and major adverse cardiovascular and cerebrovascular events (MACCE). This association holds even without visible bleeding.
Area of Science:
- Cardiology
- Hematology
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.
- The prognostic implications of in-hospital hemoglobin changes post-PCI require further investigation.
Purpose of the Study:
- To investigate the association between in-hospital hemoglobin decline and long-term outcomes in STEMI patients treated with primary PCI.
- To determine if hemoglobin decline predicts mortality and major adverse cardiovascular and cerebrovascular events (MACCE).
Main Methods:
- Retrospective analysis of adult STEMI patients undergoing primary PCI.
- Hemoglobin levels measured at admission and 48-72 hours post-procedure.
- Patients categorized into low (<3 g/dL decline) and high (≥3 g/dL decline) hemoglobin change groups.
- Primary endpoint: long-term all-cause mortality. Secondary endpoint: MACCE.
Main Results:
- The high hemoglobin decline group (n=111) exhibited a significantly higher mortality rate (65%) compared to the low decline group (n=665, 28%).
- Propensity score matching confirmed higher mortality (52% vs 32%) and MACCE rates (71% vs 52%) in the high decline group.
- The association persisted even in the absence of overt bleeding.
Conclusions:
- In-hospital hemoglobin decline is a significant independent predictor of long-term mortality and MACCE in STEMI patients treated with primary PCI.
- Monitoring hemoglobin trends may aid in risk stratification for STEMI patients.
Objective:
To explore the association between in-hospital haemoglobin decline and long-term mortality and major adverse cardiovascular and cerebrovascular events (MACCE) among ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
Methods:
This retrospective analysis included adult patients who underwent primary PCI for STEMI. Haemoglobin levels were recorded at admission and 48-72 h later. Patients were divided into two groups based on the extent of haemoglobin decline: low (<3 g/dl or no decline) and high (≥3 g/dl). The primary endpoint was all-cause mortality at long-term follow-up. The secondary endpoint was MACCE.
Results:
Patients were divided into two groups: low group (n = 665) and high group (n = 111). The mortality rate was significantly higher in the high group (72 of 111 patients; 65%) than in the low group (185 of 655 patients; 28%). Propensity score matching confirmed this association, with higher mortality (41 of 79 patients [52%] versus 25 of 79 patients [32%]) and MACCE rates (56 of 79 patients [71%] versus 41 of 79 patients [52%]) in the high group compared with the low group, respectively.
Conclusion:
There was a significant association between in-hospital haemoglobin decline, even without visible bleeding, and increased long-term mortality and MACCE in STEMI patients undergoing primary PCI.
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