Effect of anemia on 1-year mortality in patients with acute myocardial infarction

Background: Limited data are available on the effect of anemia on mortality in patients with acute myocardial infarction (MI). Methods: We examined the association of anemia with mortality at 1 year among 30,341 patients hospitalized with acute MI in 1986 (prethrombolytic era, n = 15,584) and 1996 (thrombolytic era, n = 14,757). The records were obtained from the Myocardial Infarction Data Acquisition System, a database of all patients with MI admitted to nonfederal hospitals in New Jersey. Results: Anemia was present in 996 patients (6.4%) in 1986 and 1510 patients (10.2%, P <0001) in 1996. In both years, patients with anemia were older, more frequently female and nonwhite, and more likely to have left ventricular dysfunction, non-Q MI and coronary artery bypass graft. In addition, in 1996, patients with anemia were more likely to undergo percutaneous transluminal coronary angioplasty and less likely to have a history of MI. One-year mortality was lower overall in 1996 compared with 1986 (1996 23.6%, 95% Cl 22.9-24.3 vs 1986 24.9%, 95% Cl 24.2-25.6, P = .0001). In both years, patients with anemia had significantly higher unadjusted risk for 1-year mortality (RR = 1.40, P = .0001 in both years). However, after controlling for demographics, left ventricular dysfunction, arrhythmias, Q versus non-Q MI, comorbid conditions, and revascularization procedures in a multivariable regression model, 1-year mortality in the anemia group was similar to the nonanemia group in both years. Conclusion: In the Myocardial Infarction Data Acquisition System database, anemia appears to have no significant direct effect on 1-year mortality. The higher unadjusted mortality observed among patients with acute MI and anemia is probably the result of older age, higher comorbidity, and more left ventricular dysfunction.