Impact of Anemia and Iron Deficiency on Outcomes in Cardiogenic Shock Complicating Acute Myocardial Infarction
Danilo Obradovic, Goran Loncar, Uwe Zeymer, Janine Pöss, Hans‐Josef Feistritzer, Anne Freund, Alexander Jobs, Georg Fuernau, Steffen Desch, Uta Ceglarek, Berend Isermann, Stephan von Haehling, Stefan D. Anker, Petra Büttner, Holger Thiele- Cardiology and Cardiovascular Medicine
Abstract
Objectives
This study aimed to assess the impact of anemia and iron deficiency (ID) on clinical outcome in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
Background
Anemia and ID are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and AMI. Nevertheless, data concerning the impact of anemia and ID on clinical outcome in patients with CS are scarce.
Methods
The presence of anemia (hemoglobin <13 g/dl in male and <12 g/dl in female patients) or ID (ferritin <100 ng/mL or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT‐SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in 4 groups of patients having neither anemia nor ID, against patients with anemia with or without ID and patients with ID only.
Results
A total of 427 CS patients were included in this analysis. Anemia without ID was diagnosed in 93 (21.7%), anemia with ID in 54 study participants (12.6%), ID without anemia in 72 patients (16.8%), whereas in 208 patients neither anemia nor ID was present (48.9%). CS patients with anemia without ID were older (73±10 years, p=0.001), had more frequently a history of arterial hypertension (72.8%, p=0.01), diabetes mellitus (47.8%, p=0.001), as well as chronic kidney disease (14.1%, p=0.004) compared to CS patients in other groups. Anemic CS patients without ID presence were at higher risk to develop a composite from all‐cause death or renal replacement therapy at 30‐day follow‐up (Odds ratio [OR] 3.83, 95% confidence interval [CI]: 2.23 – 6.62, p<0.001) than CS patients without anemia/ID. The presence of ID in CS patients, with and without concomitant anemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI: 0.64 – 2.13, p=0.64; and OR 1.01, 95% CI: 0.59 – 1.73, p=0.54; respectively) within 30‐days of follow‐up. In time‐to‐event Kaplan‐Meier analysis, anemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI: 1.52 – 2.89, p<0.001), as well as for death from any cause (HR 1.90, 95% CI: 1.36 – 2.65, p<0.001) and renal replacement therapy during 30‐day follow‐up (HR 2.99, 95% CI: 1.69 – 5.31, p<0.001).
Conclusion
Concomitant anemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcome in patients with CS.