Association between haemoglobin decline and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention

Abstract

Objective: To explore the association between in-hospital haemoglobin decline and long-term mortality and major adverse cardiovascular and cerebrovascular events (MACCE) among ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).

Methods: This retrospective analysis included adult patients who underwent primary PCI for STEMI. Haemoglobin levels were recorded at admission and 48-72 h later. Patients were divided into two groups based on the extent of haemoglobin decline: low (<3 g/dl or no decline) and high (≥3 g/dl). The primary endpoint was all-cause mortality at long-term follow-up. The secondary endpoint was MACCE.

Results: Patients were divided into two groups: low group (n = 665) and high group (n = 111). The mortality rate was significantly higher in the high group (72 of 111 patients; 65%) than in the low group (185 of 655 patients; 28%). Propensity score matching confirmed this association, with higher mortality (41 of 79 patients [52%] versus 25 of 79 patients [32%]) and MACCE rates (56 of 79 patients [71%] versus 41 of 79 patients [52%]) in the high group compared with the low group, respectively.

Conclusion: There was a significant association between in-hospital haemoglobin decline, even without visible bleeding, and increased long-term mortality and MACCE in STEMI patients undergoing primary PCI.

Keywords: Haemoglobin decline; ST-segment elevation myocardial infarction; STEMI; long-term mortality; primary percutaneous coronary intervention.

Figure 1.

Mortality before propensity score matching in the entire cohort of patients (n = 766) who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 2.

Major cardiovascular and cerebrovascular events (MACCE) before propensity score matching in the entire cohort of patients (n = 766) who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 3.

Mortality before propensity score matching in patients (n = 94) with overt bleeding who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 4.

Major cardiovascular and cerebrovascular events (MACCE) before propensity score matching in patients (n = 94) with overt bleeding who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 5.

Mortality after propensity score matching in patients (n = 158) who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 6.

Major cardiovascular and cerebrovascular events (MACCE) after propensity score matching in patients (n = 158) who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 7.

Mortality after propensity score matching in patients (n = 37) with overt bleeding who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 8.

Major cardiovascular and cerebrovascular events (MACCE) after propensity score matching in patients (n = 37) with overt bleeding who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention who were enrolled in a study investigating the association between in-hospital haemoglobin decline and long-term mortality. Patients were stratified according to the extent of haemoglobin decline into low and high groups. The colour version of this figure is available at: http://imr.sagepub.com.