Abstract 3166: Blood Transfusion and Clinical Outcomes in Patients with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Doron Aronson ◽  
Michael Kapeliovich ◽  
Walter Markiewicz ◽  
Haim Hammerman
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Interquartile Range ◽  
Killip Class ◽  
Coronary Syndromes ◽  
To Receive ◽  
The Relationship ◽  
Baseline Hemoglobin

Introduction: The safety of red blood cells transfusion (RBC-T) in patients (pts) with acute coronary syndromes is controversial, with some studies suggesting that RBC-T may adversely affect outcome. Methods: We studied the relationship between RBC-T during hospitalization and 6-months mortality in 2325 pts with acute myocardial infarction (AMI).Propensity score for RBC-T was calculated based on a logistic regression model incorporating age, sex, baseline hemoglobin (Hb), creatinine, diabetes, smoking, blood pressure and heart rate, Killip class, thrombolytic therapy and coronary interventions. The association between RBC-T and mortality was assessed using Cox mode with RBC-T as a time-dependent covariate, adjusting for the propensity to receive RBC-T and nadir Hb prior to RBC-T. Results: One hundred and ninety one pts (8.2%) received RBC-T. Median nadir Hb was markedly lower in pts receiving RBC-T (8.8 gr/dL [interquartile range 8.2–9.3]) compared with pts not receiving RBC-T (12.8 gr/dL [interquartile range 11.6 –13.9]; P < 0.0001). Mortality increased progressively in pts receiving RBC-T over the 6-months follow-up (Figure ). The unadjusted hazard ratio (HR) for mortality in pts receiving RBC-T was 4.1 (95% CI 3.0 –5.7, P < 0.0001). The effect of RBC-T was attenuated but remained significant after adjustments for the propensity to receive RBC-T (HR 2.1; 95% CI 1.4 –3.2, P < 0.0001). However, after adjusting for nadir Hb, the association between RBC-T and mortality was not significant (HR 1.4; 95% 0.9 –2.1, P = 0.09). Conclusion: The transfusion-associated risk in patients with AMI reflects the severity of the anemia at the time of transfusion and associated comorbidities.

scholarly journals An Overview of Glycemic Control in the Coronary Care Unit with Recommendations for Clinical Management

2009 ◽  
Vol 3 (6) ◽  
pp. 1342-1351 ◽  
Author(s):  
Mikhail Kosiborod ◽  
Prakash Deedwania
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Coronary Care Unit ◽  
Elevated Glucose ◽  
Coronary Syndromes ◽  
Coronary Care ◽  
Glucose Management ◽  
The Relationship ◽  
Intense Debate

The observation that elevated glucose occurs frequently in the setting of acute myocardial infarction was made decades ago. Since then numerous studies have documented that hyperglycemia is a powerful risk factor for increased mortality and in-hospital complications in patients with acute coronary syndromes. While some questions in this field have been answered in prior investigations, many critical gaps in knowledge continue to exist and remain subjects of intense debate. This review summarizes what is known about the relationship between hyperglycemia, glucose control, and outcomes in critically ill patients with acute coronary syndromes, addresses the gaps in knowledge and controversies, and offers general recommendations regarding glucose management in the coronary care unit.

Abstract 327: Gender Differences In The Association Between Hemoglobin Change After Acute Myocardial Infarction And Outcomes

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lauren E Thompson ◽  
Frederick A Masoudi ◽  
Kensey L Gosch ◽  
Pamela N Peterson ◽  
Adam C Salisbury ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Similar Magnitude ◽  
Men And Women ◽  
Absolute Change ◽  
Hospitalization Rates ◽  
Lower Baseline ◽  
The Relationship ◽  
Baseline Hemoglobin

Background: Hemoglobin decline following acute myocardial infarction (AMI) is associated with long-term morbidity. Since women have lower baseline hemoglobin levels than men, whether the same absolute change in hemoglobin after AMI similarly affects outcomes in women and men is unknown. Methods: We examined patients discharged after AMI in the TRIUMPH registry between 2005 and 2008 who had admission and discharge hemoglobin levels. We compared the relationship between absolute change in hemoglobin during hospitalization with 6- and 12-month mortality and re-hospitalization by gender after adjusting for clinical variables including admission hemoglobin. Results: Of the 4,243 patients with AMI, 33% (1,400 of 4,243) were women. Women were older, had more co-morbidities, and were less likely to present with STEMI, or receive catheterization. Women had lower admission hemoglobin (12.9 g/dL ± 1.9 vs 14.5 ± 2.0, p= <0.01) and a smaller mean absolute change in hemoglobin during hospitalization (-1.5 g/dL ± 1.8 vs -1.6 ±1.8, p = 0.01) compared to men. The association between hemoglobin declines during hospitalization and mortality and re-hospitalization rates at 6 and 12-months were of a similar magnitude between men and women (all interaction p > 0.05). (Figure 1) Conclusion: Although women with AMI had lower admission hemoglobin values, similar declines in hemoglobin during hospitalization were associated with increases in mortality and re-hospitalization in women and men. These findings suggest that absolute change in hemoglobin is equally important at predicting outcomes in women and men, regardless of admission hemoglobin levels.

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