August 17, 2017
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Acute MI in sickle cell anemia may confer poor outcomes

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Patients with sickle cell anemia had an acute MI at an earlier age and an increased risk for hospital mortality compared with patients without sickle cell anemia, according to a study published in The American Journal of Cardiology.

Gbolahan O. Ogunbayo , MD, a first-year fellow at the University of Kentucky College of Medicine in Lexington, and colleagues analyzed data from 2,386,647 admissions for patients with acute MI; 501 patients had sickle cell anemia.

From the total admissions, 495 patients with sickle cell anemia (mean age, 47 years; 53% women; 88% black) were matched with patients without sickle cell anemia.

Inpatient all-cause mortality was the primary outcome of interest. Secondary outcomes were in-hospital complications, including cardiac arrest and length of hospital stay, in addition to need for dialysis, intubation or blood transfusion.

Patients with sickle cell anemia were less likely to have hypertension, hyperlipidemia or diabetes and to be smokers vs. those without sickle cell anemia. Compared with patients without sickle cell anemia, those with the condition were more likely to develop respiratory failure (34.9% vs. 14.1%; P < .001), pneumonia (22.8% vs. 10.3%; P < .001) and acute renal failure (29.9% vs. 20%; P < .001). In addition, they were more likely to require hemodialysis for acute renal failure (7.7% vs. 3%; P = .001), mechanical ventilation (26.7% vs. 13.1%; P < .001) and blood transfusion (42.6% vs. 9.3%; P < .001).

The occurrence of in-hospital mortality was higher in patients with sickle cell anemia (18.2%) vs. those without sickle cell anemia (6.7%; P < .001).

In a multivariate analysis, sickle cell anemia was an independent predictor of mortality (OR = 3.49; 95% CI, 1.99-6.12).

“Patients with [sickle cell anemia] are prone to end-organ damage due to chronic vascular injury,” Ogunbayo and colleagues wrote. “This likely places them at an increased risk of systemic complications such as pneumonia, respiratory failure and acute renal failure. Secondly, patients with [sickle cell anemia] are more likely to present with atypical clinical features, making the diagnosis of [acute] MI difficult, therefore delaying guideline-directed therapy.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.