Guidelines-based treatment of anaemic STEMI patients: Practice patterns and effects on in-hospital mortality: A retrospective analysis from the NCDR

Robert F. Riley, L. Kristin Newby, Creighton W. Don, Karen P. Alexander, Eric D. Peterson, S. Andrew Peng, Sanjay K. Gandhi, Michael A. Kutcher, Ezra A. Amsterdam, David M. Herrington

Research output: Contribution to journalArticlepeer-review

Abstract

Anaemia is associated with an increased risk for morbidity and mortality in ST-elevation myocardial infarction (STEMI) patients. While several physiological mechanisms have been proposed to explain this association, decreased receipt of guidelines-based care may also contribute. We examined the relationship between admission haemoglobin (Hgb) level, receipt of ACC/AHA guidelines-based treatments, and in-hospital outcomes among STEMI patients. We also evaluated whether administration of these treatments modified the association between anaemia and in-hospital mortality in this group. We analysed data from 92,686 patients diagnosed with STEMI included in the NCDR ACTION Registry-GWTG database from January 2007 to March 2011. Patients were stratified by initial Hgb value: 83.1% (n=77,035) were classified as non-anaemic (Hgb 13.0 g/dl for men, 12.0 g/dl for women), 11.6% (n=10,710) as mildly anaemic (11.1−13.0 g/dl for men, 11.1−12.0 g/dl for women), 4.4% (n=4059) as moderately anaemic (9.1−11.0 g/dl), and 1.0% (n=882) as severely anaemic (<9.0 g/dl). Anaemia was associated with a significantly increased prevalence of other baseline comorbidities and decreased odds of receiving several class I recommended pharmacological treatments (heparin, beta-blockers, and angiotensin-converting enzyme inhibitors, p<0.01). The overall use of reperfusion therapy (fibrinolytic therapy and/or percutaneous coronary intervention) was also lower in anaemic vs. non-anaemic patients (p<0.01). Anaemia was associated higher in-hospital mortality risk, which remained significant after adjustment for use of guidelines-recommended therapies and interventions (p<0.01). In a national sample of STEMI patients, anaemia on presentation was associated with decreased receipt of ACC/AHA guidelines-based care and higher in-hospital mortality. However, the higher mortality rates could not be fully explained by differences in in-hospital treatment.

Original languageEnglish (US)
Pages (from-to)35-43
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume2
Issue number1
DOIs
StatePublished - Mar 2013
Externally publishedYes

Keywords

  • Anaemia
  • guidelines
  • outcomes
  • ST-segment myocardial infarction (STEMI)
  • treatment

ASJC Scopus subject areas

  • Medicine(all)

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