IMPACT OF ANEMIA ON OUTCOMES IN ACUTE CORONARY SYNDROME: A CLINICAL, PATHOPHYSIOLOGICAL AND BIOCHEMICAL PERSPECTIVE
Main Article Content
Keywords
Acute Coronary Syndrome, Myocardial Infarction, Shock, Anemia.
Abstract
Objective: To determine the outcome in hospital anemic patients presenting with acute coronary syndrome.
Methodology: A single centred, prospective, cross-sectional study conducted from June 10 to December 09, 2022 on 147 patients with acute coronary syndrome along with anemia admitted in cardiology department of Sheikh Zayed Medical College/Hospital were included in the study after fulfilling inclusion criteria. Labs were recorded to document anemia (labelled as Hb less than 10mg/dl); along with other demographics and study parameters. These cases were followed to look for in- hospital cardiogenic shock, heart failure, recurrent infarction and/or death.
Results: In this study there were total 143 cases out of which 93(65.03%) were males and 50(34.97%) females with mean age was 49.59±6.03 years. The frequency of DM was 21(14.69%), HTN was 47(32.87%), smoking was 38(26.57%). In the present study, cardiogenic shock was seen in 27(18.88%), heart failure in 32(23.38%), recurrent infarction in 28(19.58%) and mortality was seen in 8(5.59%) of cases. There was significantly high cases of cardiogenic shock in cases with STEMI affecting 22 out of 82 cases with p=0.03. Heart failure was also significantly high in cases with STEMI where it was seen in 23 out of 82 cases with p values of 0.04. Recurrent infarction was significantly high in cases with Hb less than 7 where it was seen in 11 out of 53 cases with p=0.04 and with STEMI with p=0.03. Mortality was also significantly high in cases with Hb less than 7g/dl where it was seen in 5 out of 53 cases.
Conclusion: Complications are higher in cases having acute coronary syndrome along with anemia and the most common one seen is heart failure. Furthermore, cardiogenic shock, heart failure, recurrent infarction are significantly associated with STEMI while, recurrent infarction and mortality are significantly high in cases with Hb less than 7mg/dl.
Methodology: A single centred, prospective, cross-sectional study conducted from June 10 to December 09, 2022 on 147 patients with acute coronary syndrome along with anemia admitted in cardiology department of Sheikh Zayed Medical College/Hospital were included in the study after fulfilling inclusion criteria. Labs were recorded to document anemia (labelled as Hb less than 10mg/dl); along with other demographics and study parameters. These cases were followed to look for in- hospital cardiogenic shock, heart failure, recurrent infarction and/or death.
Results: In this study there were total 143 cases out of which 93(65.03%) were males and 50(34.97%) females with mean age was 49.59±6.03 years. The frequency of DM was 21(14.69%), HTN was 47(32.87%), smoking was 38(26.57%). In the present study, cardiogenic shock was seen in 27(18.88%), heart failure in 32(23.38%), recurrent infarction in 28(19.58%) and mortality was seen in 8(5.59%) of cases. There was significantly high cases of cardiogenic shock in cases with STEMI affecting 22 out of 82 cases with p=0.03. Heart failure was also significantly high in cases with STEMI where it was seen in 23 out of 82 cases with p values of 0.04. Recurrent infarction was significantly high in cases with Hb less than 7 where it was seen in 11 out of 53 cases with p=0.04 and with STEMI with p=0.03. Mortality was also significantly high in cases with Hb less than 7g/dl where it was seen in 5 out of 53 cases.
Conclusion: Complications are higher in cases having acute coronary syndrome along with anemia and the most common one seen is heart failure. Furthermore, cardiogenic shock, heart failure, recurrent infarction are significantly associated with STEMI while, recurrent infarction and mortality are significantly high in cases with Hb less than 7mg/dl.
References
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12. Rai, A., Babanejad, M., Sanadgol, S., Karim, H., Janjani, P., Rai, A. R., & Shahmohammadi, A. (2020). Investigation of anemia risk factors and its related outcomes in patients with ST-elevation myocardial infarction. The Medical Journal of the Islamic Republic of Iran, 34(1), 113. https://doi.org/10.34171/mjiri.34.113
13. Pei J, Wang X, Chen P, Zheng K and Hu X (2021) Hb Levels and Sex Differences in Relation to Short-Term Outcomes in Patients With Acute Myocardial Infarction. Front. Cardiovasc. Med. 8:653351. doi: 10.3389/fcvm.2021.653351
2. https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/ syc-20351360
3. Stucchi M, Cantoni S, Piccinelli E, Savonitto S, Morici N. Anemia and acute coronary syndrome: current perspectives. Vasc Health Risk Manag. 2018 May 30;14:109-118. doi: 10.2147/VHRM.S140951. PMID: 29881284; PMCID: PMC5985790.
4. Vicente-Ibarra N, Marín F, Pernías-Escrig V, Sandín-Rollán M, Núñez-Martínez L, Lozano T, Macías-Villaniego MJ, Carrillo-Alemán L, Candela-Sánchez E, Guzmán E, Esteve- Pastor MA, Orenes-Piñero E, Valdés M, Rivera-Caravaca JM, Ruiz-Nodar JM. Impact of anemia as risk factor for major bleeding and mortality in patients with acute coronary syndrome. Eur J Intern Med. 2019 Mar;61:48-53. doi: 10.1016/j.ejim.2018.12.004. Epub 2018 Dec 20. PMID: 30579651.
5. Johannes Reinhold, Charikleia Papadopoulou, Ranu Baral, Vassilios S. Vassiliou. Iron deficiency for prognosis in acute coronary syndrome – A systematic review and meta- analysis, International Journal of Cardiology, Volume 328, 2021, Pages 46-54, ISSN 0167-5273, https://doi.org/10.1016/j.ijcard.2020.12.021.
6. Muhammed T. Gürgöze, Isabella Kardys, K. Martijn Akkerhuis, Rohit M. Oemrawsingh, Hilde E. Groot, Pim van der Harst, Victor A. Umans, Bas Kietselaer, Eelko Ronner, Timo Lenderink, Folkert W. Asselbergs, Olivier C. Manintveld, Eric Boersma. Relation of Iron Status to Prognosis After Acute Coronary Syndrome, The American Journal of Cardiology, Volume 168, 2022, Pages 22-30, ISSN 0002-9149, https://doi.org/10.1016/j.amjcard.2021.12.022.
7. https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/symptoms- causes/syc-20352136
8. James, Stefan, and Héctor Bueno, 'Epidemiology of acute coronary syndromes', The ESC Textbook of Cardiovascular Medicine, 3 edn, The European Society of Cardiology Series (Oxford, 2018; online edn, ESC Publications, 1 July 2018), https://doi.org/10.1093/med/ 9780198784906.003.0305, accessed 1 July 2024.
9. Usman, M., Javed, B., Ahmed, A., Muneeb, M., Chatha, Z. J., & Nigar, A. (2023). Frequency of anemia in patients with acute coronary syndrome. Pakistan Journal of Medical & Health Sciences, 17(6), 312–314. https://doi.org/10.53350/pjmhs2023176312
10. Lorente, V., Aboal, J., Garcia, C., Sans-Roselló, J., Sambola, A., Andrea, R., Tomás, C., Bonet, G., Viñas, D., Ouaddi, N. E., Montero, S., Cantalapiedra, J., Pujol, M., Hernández, I., Pérez-Rodriguez, M., Llaó, I., Sánchez-Salado, J. C., Gual, M., & Ariza-Solé, A. (2020). Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units. PubMed, 17(1), 35–42. https://doi.org/10.11909/j.issn.1671-5411.2020.01.006
11. Christian Jung, Richard Rezar, Patricia Wischmann, Maryna Masyuk, Christian Datz, Raphael Romano Bruno, Malte Kelm, Bernhard Wernly, The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses, International Journal of Cardiology, Volume 367, 2022, Pages 1-10, ISSN 0167-5273, https:// doi.org/10.1016/j.ijcard.2022.08.052. (https://www.sciencedirect.com/science/article/pii/ S0167 527322012621)
12. Rai, A., Babanejad, M., Sanadgol, S., Karim, H., Janjani, P., Rai, A. R., & Shahmohammadi, A. (2020). Investigation of anemia risk factors and its related outcomes in patients with ST-elevation myocardial infarction. The Medical Journal of the Islamic Republic of Iran, 34(1), 113. https://doi.org/10.34171/mjiri.34.113
13. Pei J, Wang X, Chen P, Zheng K and Hu X (2021) Hb Levels and Sex Differences in Relation to Short-Term Outcomes in Patients With Acute Myocardial Infarction. Front. Cardiovasc. Med. 8:653351. doi: 10.3389/fcvm.2021.653351
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Published
Aug 20, 2024
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How to Cite
Dr. Abdul Majid, Dr. Ayesha Zubair, Dr. Neelam Ijaz, Dr. Amna Akram, Dr. Fahad Sarfraz, & Dr. Shama Iqbal. (2024). IMPACT OF ANEMIA ON OUTCOMES IN ACUTE CORONARY SYNDROME: A CLINICAL, PATHOPHYSIOLOGICAL AND BIOCHEMICAL PERSPECTIVE. Journal of Population Therapeutics and Clinical Pharmacology, 31(8). https://doi.org/10.53555/45nyd005
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Author Biographies
Dr. Abdul Majid
Associate Professor, Department of Cardiology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan.
Dr. Ayesha Zubair
Assistant Professor, Department of Biochemistry, CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
Dr. Neelam Ijaz
Senior Demonstrator, Department of Biochemistry, Al Aleem Medical College Lahore, Gulab Devi Hospital, Lahore, Pakistan
Dr. Amna Akram
Assistant Professor, Department of Biochemistry, Sahara Medical College, Narowal
Dr. Fahad Sarfraz
Associate Professor, Department of Medical Education, CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
Dr. Shama Iqbal
Associate Professor, Department of Physiology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
How to Cite
Dr. Abdul Majid, Dr. Ayesha Zubair, Dr. Neelam Ijaz, Dr. Amna Akram, Dr. Fahad Sarfraz, & Dr. Shama Iqbal. (2024). IMPACT OF ANEMIA ON OUTCOMES IN ACUTE CORONARY SYNDROME: A CLINICAL, PATHOPHYSIOLOGICAL AND BIOCHEMICAL PERSPECTIVE. Journal of Population Therapeutics and Clinical Pharmacology, 31(8). https://doi.org/10.53555/45nyd005