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70 Treatment-risk paradox in non st-elevation acute coronary syndromes: how does the anaemia contribute?
  1. Zainab Dakhil
  1. Ibn Al Bitar Cardiac Centre, Al-Kindy College of Medicine/university of Baghdad, Baghdad, Iraq


Background It is not long since researchers started to shed light on management disparities like treatment-risk paradox in NSTE-ACS in emerging countries, including Iraq. We find it is crucial to address the possible contributing factors for this phenomenon, one of the proposed underlying causes for treatment-risk paradox is anaemia.

Purpose This study aimed to investigate the impact of anaemia on decision and timing of intervention in NSTE-ACS.

Methods Admitted patients with NSTE-ACS were prospectively recruited, their baseline characteristics, management strategy (invasive vs conservative) and timing to intervention if done; all were recorded. Then they were grouped into anaemic (Hb<13 in male, <12 in female) vs non-anaemic, GRACE risk score was calculated, so stratified into low, intermediate and high with scores <109, 109-140 and >140 respectively.

Results Total n.=183, 32.8% were anaemic, anaemic patients were older (62.6±10.9 vs 56.8±11.6, p=0.001), more to be females (45% vs 24.4%, p=0.005) and more to report prior history of IHD (65% vs 44.7%, p=0.01), anaemic patients were less to be smokers versus non -anaemic counterparts (23.3% vs 37.4%, p=0.04). Anaemic group were more to have dyspnea at presentation (48.3% vs 26.8%, p=0.004). Anaemic patients were more at high GRACE risk class (35% vs 30.1%) and more to develop acute heart failure (AHF) (35% vs 15.4%, p=0.003) than their non-anaemic counterparts, yet, they were less to be treated invasively (48.3% vs 72.4%, p=0.001). However, at high risk class they were more to be catheterized than non-anaemics and more to be catheterized within <72 hours (54.5% vs 43.8%) while at low risk class non-anaemics were more to be catheterized within < 72 hours (34.7% vs 28.6%), see figure 1.

Conclusion Anaemia in NSTE-ACS occurs more in elderly, females and high GRACE risk class patients, anaemic patients had higher rate of AHF and were less to be catheterized in general, yet more to be catheterized if they were at high risk class but with delayed timing. Future studies are warranted to provide further insights on risk stratification and targeted therapies for those patients.

Conflict of Interest None

  • Disparity
  • Risk stratification
  • GRACE Score

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