Title : The impact of anemia on long-term mortality among post-acute myocardial infarction patients according to different levels of chronic kidney disease
Abstract:
Background: Anemia has been shown to be adversely associated with outcomes following acute myocardial infarction (AMI). Anemia is often related to chronic kidney disease (CKD) which is prevalent among AMI patients.
Aims: To evaluate the prognostic effect of anemia by different levels of CKD among patients following AMI.
Methods: AMI patients hospitalized in a tertiary Medical Center through 2002-2017 were studied. Exclusion criteria: patients who died in-hospital, lack of laboratory test results within 24 hours of admission. Anemia was defined as hemoglobin level <12 mg/dL or <13 mg/dL upon admission in women and in men respectively. CKD was classified according to the KDIGO (2012) and presented in six categories, based on the eGFR upon admission. The primary outcome was all-cause mortality up-to ten years after hospital discharge. Statistical analysis included survival approach.
Results: The study included an overall of 11,395 patients, age 68±13.9 years, 69.1% men. The rate of anemia increased with the degree of CKD: from 16.4% in G1 to 71.5% in G5 groups (p-for-trend <0.001). Patients with higher CKD level were generally older with higher rate of most comorbidities and some cardiovascular risk factors (hypertension, diabetes mellitus) and lower rate of other (smoking, obesity dyslipidemia), of STEMI and of interventional revascularization therapies. Throughout a median follow-up of 3476 days (~9.5 years) a total of 5446 patients died (47.8%), significantly higher among patients with anemia vs. without anemia (75.3% vs. 36.1%, p<0.001) and with increasing level of CKD (25.5% for G1 vs. 90.9% for G5, p-for-trend <0.001). Mortality rates were higher among patients with anemia for every level of CKD. A multivariate interactive model adjusted to potential confounders showed significantly higher relative risk for mortality for anemia (adjHR=1.911, 95%CI: 1.670-2.188, p<0.001) and for greater degree of CKD (adjHR=1.261, 95%CI: 1.220-1.304 for one stage increase, p-for-trend<0.001). However, mostly significant and prominent burden of anemia was observed in patients with lower degrees of CKD (p-for interaction <0.001).
Conclusions: Anemia among AMI survivors with CKD is adversely associated with survival, particularly among patients with relatively mild CKD.
What will audience learn from your presentation?
- Baseline characteristics of AMI survivors with anemia significantly differ according to CKD levels.
- Anemia and CKD are independently associated with significantly increased risk for long term mortality among AMI survivors.
- The most significant and prominent impact of anemia over mortality is among patients with mild rather than severe CKD.
