The role of anemia on admission in acute coronary syndrome - An umbrella review of systematic reviews and meta-analyses

ElsevierVolume 367, 15 November 2022, Pages 1-10International Journal of CardiologyHighlights•

Patients with ACS and anemia on admission have a worse outcome compared to patients without anemia.

The transfusion of red blood cells is associated with a higher mortality in ACS patients.

Anemia is a common finding in ACS, yet the optimal management of anemic ACS patients is unclear based on the available evidence.

AbstractIntroduction

The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O).

Methods

We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality.

Results

Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70–2.55) and transfusion (1.93 95%CI 1.12–3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70–1-05), administration of ESA (RR 0.55 95%CI 0.22–1.33) and iron deficiency (OR 1.24 95%CI 0.12–13.13) were not associated with altered all-cause mortality.

Conclusion

Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.

Keywords

Anemia

ACS

Transfusion

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