Document Detail


Impact of anemia on clinical outcomes of patients with ST-segment elevation myocardial infarction in relation to gender and adjunctive antithrombotic therapy (from the HORIZONS-AMI trial).
MedLine Citation:
PMID:  20451683     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of this study was to assess the impact of baseline anemia on the outcomes of patients with ST elevation myocardial infarctions who underwent primary percutaneous coronary intervention in relation to contemporary adjunctive antithrombotic therapy and gender. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients were randomized to bivalirudin alone or to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor before primary percutaneous coronary intervention. Outcomes were assessed at 30 days and 1 year according to anemia and gender. Baseline anemia was present in 331 of 3,153 patients (10.5%). Patients with versus without baseline anemia had a more than twofold increase in major bleeding at 30 days (13.5% vs 6.7%, p <0.0001) and at 1 year (14.8% vs 7.2%, p <0.0001), an association that on multivariate analysis was independent of gender. Mortality was significantly higher in men with versus without baseline anemia (4.6% vs 1.8% at 30 days, p = 0.003; 8.9% vs 3.0% at 1 year, p <0.0001) but not in women (5.3% vs 3.6% at 30 days, p = 0.42; 7.5% vs 5.9% at 1 year, p = 0.54). On multivariate analysis, anemia independently predicted 1-year all-cause mortality in men but not in women. Bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor resulted in twofold lower rates of all-cause and cardiac mortality and major bleeding in patients without but not in those with baseline anemia. In conclusion, baseline anemia was associated with increased major bleeding and death in patients with ST elevation myocardial infarctions who underwent primary PCI but was a stronger predictor of early and late mortality in men than in women. Paradoxically, in this post hoc analysis, the reductions in major bleeding and mortality in ST elevation myocardial infarction afforded by bivalirudin occurred primarily in patients without baseline anemia.
Authors:
Kenichi Tsujita; Eugenia Nikolsky; Alexandra J Lansky; George Dangas; Martin Fahy; Bruce R Brodie; Dariusz Dudek; Martin M?ckel; Andrzej Ochala; Roxana Mehran; Gregg W Stone
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-04-02
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1385-94     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anemia / complications,  diagnosis*,  mortality,  therapy
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Combined Modality Therapy
Drug Therapy, Combination
Electrocardiography
Female
Fibrinolytic Agents / administration & dosage*
Follow-Up Studies
Heparin / administration & dosage
Hirudins / administration & dosage
Hospital Mortality / trends
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / complications,  diagnosis,  mortality*,  therapy*
Neoadjuvant Therapy / methods
Peptide Fragments / administration & dosage
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Probability
Proportional Hazards Models
Recombinant Proteins / administration & dosage
Risk Assessment
Sex Factors
Survival Analysis
Thrombolytic Therapy / methods
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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