ORIGINAL ARTICLES   

Minerva Cardioangiologica 2010 February;58(1):1-10

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Iron deficiency anemia and cardiac mortality in patients with left ventricular systolic dysfunction undergoing coronary stenting

Varma A. ¹, Appleton D. L. ¹, Nusca A. ², Lipinski M. J. ³, Goudreau E. ¹, Cowley M. J. ¹, Wittkamp M. ¹, Vetrovec G. W. ¹, Abbate A. ¹ ✉

¹ Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA; ² University Campus Bio-Medico, Department of Cardiovascular Medicine, Rome, Italy; ³ University of Virginia, Department of Internal Medicine, Charlottesville, VA, USA

AIM: The aim of this study was to assess cardiac mortality in patients with reduced ejection fraction (EF≤45%) and anemia (Hb≤12 g/dL) undergoing coronary stenting and to investigate whether iron-deficiency anemia influenced outcome when compared to non-anemic patients or patients with other types of anemia.
METHODS: One hundred twenty consecutive patients undergoing percutaneous coronary intervention (PCI) between April 2003 and December 2005 were identified and followed for a median of 30 months. Patients were divided into 2 groups, anemic (Hb≤12 g/dL) and non-anemic. Anemic patients were then divided into 3 sub-groups based on laboratory analysis and anemia work-up: iron-deficiency, malignancy-associated, and anemia of chronic disease (including chronic kidney disease). Mortality rates and cause of death were retrieved using both the Social Security database and the hospital records.
RESULTS: Thirty-one percent of patients had iron deficiency, 24% had a malignancy-associated anemia and 45% had anemia of chronic disease. Overall mortality was 12% of which 29% was cardiac death. All-cause and cardiac mortality were significantly higher in anemic vs. non-anemic patients, (31% vs. 6%, P<0.001, and 10% vs. 1%, P=0.016, respectively). Iron-deficiency anemia strongly predicted cardiac mortality (33% vs. 1% in non-anemic patients, P<0.001), while malignancy-associated anemia was the strongest predictor of non-cardiac death (57% vs. 4% in non-anemic patients, P<0.001). Anemia of chronic disease neither predicted cardiac nor non-cardiac death.
CONCLUSIONS: To the authors’ knowledge, this is the first study to show that iron-deficiency anemia is a strong predictor of cardiac death when compared to patients with other types of anemia or to non-anemic patients.