Acute Anemia and Myocardial Infarction

Abstract

Various studies have established the prognosis of anemia in myocardial infarction (MI). Both chronic and acute anemia lead to poor outcomes in MI. Regardless, the association of anemia with MI and its management varies. In this study, the literature was analyzed to determine the association between acute anemia and MI based on the pathophysiology, outcomes, and management options. Acute anemia results in decreased blood supply and sudden hypoxia to the heart. Additionally, it exacerbates the preexisting compromised coronary blood supply in patients with MI. Thus, there is a disproportionate oxygen supply and demand ratio to the heart. It was found that anemia increases all-cause mortality in acute MI. However, it is unclear whether anemia is the direct contributor to mortality in these patients. For the management of MI, percutaneous coronary intervention (PCI) is commonly used. Increased incidence of hospital-acquired anemia (HAA) is reported in patients after PCI. However, the cause of HAA in these patients is not well established. Antiplatelet therapy in these patients is also considered to be the culprit for HAA. Nonetheless, no clear evidence is available. There is no consensus or criteria for the treatment of acute anemia in MI patients. Researchers have explored management options such as blood transfusion, erythropoietin-stimulating agent, and iron therapy. Further studies are warranted for a better understanding and management of MI in patients with anemia and vice versa.

Keywords: anemia and mi; anemia and pci; epidemiology of anemia; pathophysiology of anemia in mi; treatment of anemia in mi.

Figure 1. Subtypes of myocardial infarction.

Copyright/License: This figure is from an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/). No modifications were made to the original figure. Chapman AR, Adamson PD, Mills NL: Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart. 2016, 103:10-8. 10.1136/heartjnl-2016-309530 [21].

Figure 2. Diagnosis of myocardial infarction.

MRI: magnetic resonance imaging; CT: computed tomography; CAD: coronary artery disease Copyright/License: This figure is from an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license (http://creativecommons.org/licenses/by/4.0/). No modifications were made to the original figure. Chapman AR, Adamson PD, Mills NL: Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart. 2016, 103:10-8. 10.1136/heartjnl-2016-309530 [21].

Figure 3. Anemia prevalence across the globe.

Southeast Asia I: Indonesia, Sri Lanka, and Thailand [28]. Southeast Asia II: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Maldives, Myanmar, and Nepal. North America: Including Cuba. Africa: Excluding Egypt, Morocco, Somalia, Sudan, and Tunisia. East Mediterranean: Afghanistan, Djibouti, Egypt, Iraq, Morocco, Pakistan, Somalia, Sudan, and Yemen. Latin America: Excluding Cuba. The image was created by one of the authors (Ayushi Mohan).