Iron deficiency in acute coronary syndromes: prevalence and prognostic impact
Ana Fátima Esteves1, Sara Gonçalves1, Tatiana Duarte1
1Rua Camilo Castelo Branco, Cardiology Department, São Bernardo Hospital, Setúbal Hospital Centre, Setúbal, Portugal.
Insights
Iron deficiency (ID) is common in acute coronary syndromes (ACS). While ID did not predict death in ACS patients, anemia showed a significant impact, and ID
Area of Science:
- Cardiology
- Internal Medicine
- Hematology
Background:
- Iron deficiency (ID) is a known prognostic marker in heart failure (HF).
- The impact of ID in acute coronary syndromes (ACS) is not well-established.
- Understanding ID's role in ACS is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the prevalence and impact of ID in patients admitted with ACS.
- To determine if ID predicts adverse events such as hemorrhage, red blood cell transfusion, hospitalizations, or death in ACS patients.
- To compare the characteristics and outcomes of ACS patients with and without ID.
Main Methods:
- Retrospective analysis of 287 patients admitted with ACS between January and December 2019.
- Patients were divided into groups with or without ID and compared based on demographics, hospitalization details, comorbidities, and echocardiographic findings.
- Predictive value of ID for hemorrhage, red blood cell transfusion, all-cause hospitalizations, and all-cause death was assessed during a median follow-up of 28 months.
Main Results:
- Iron deficiency was present in 48% of ACS patients.
- Patients with non-ST-elevation myocardial infarction were more frequently diagnosed with ID compared to those with ST-elevation myocardial infarction.
- During follow-up, patients with ID had a significantly higher rate of emergency department admissions for heart failure (HF), but ID did not predict all-cause death. Anemia, age, and NT-proBNP levels predicted all-cause death.
Conclusions:
- Iron deficiency is highly prevalent in patients with acute coronary syndromes.
- Anemia, rather than iron deficiency, appears to have a greater impact on mortality in the acute setting of ACS.
- Further research is needed to investigate the role of iron deficiency in the development of heart failure in ACS patients.
Introduction And Objectives:
Iron deficiency (ID) is a well-known prognostic marker in heart failure (HF), independent of anemia. However, its impact in acute coronary syndromes (ACSs) is not well established.
Methods:
This is a retrospective analysis of patients admitted with ACS from January to December 2019. The population was evaluated according to basal characteristics and divided in two groups, with or without ID, compared according to several variables, namely demographic, index hospitalization, comorbidities, analytical and echocardiographic. We determined their predictive value on the occurrence of hemorrhage or need for red blood cell transfusion, all-cause hospitalizations, and all-cause death.
Results:
We included 287 patients, with median age 66 (interquartile range [IQR] 21) years and 72% male. ID was present in 48% of patients. Most presented with ST-elevation myocardial infarction (STEMI) (57%), and 13% were admitted in Killip-Kimball class III or IV. Almost 40% had a left ventricle ejection fraction < 50% on admission. Patients with non-ST-elevation myocardial infarction presented more frequently with ID, compared with patients with STEMI. Of note, 33% of patients with ID had concomitant anemia. During a median follow-up of 28 (IQR 7) months, 10% had an urgent care admission for HF, 7% were hospitalized for HF, and 18% died. There was a significantly higher rate of emergency department admissions for HF in the group with ID. Age, anemia, and NT-proBNP levels predicted the occurrence of all-cause death, with ID having no impact on none of the evaluated events.
Conclusion:
ID was prevalent in patients with ACS, affecting almost half of the population. In the acute setting of an ACS, anemia seems to have a greater impact on mortality and the role of ID in promoting HF needs further investigation.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...