Age and gender mediated the association between anemia and 30-day outcomes in patients with ST-segment elevated myocardial infarction

Shan Wang; You Zhang; Datun Qi; Xianpei Wang; Zhongyu Zhu; Wei Yang; Muwei Li; Dayi Hu; Chuanyu Gao

doi:10.1016/j.ijcha.2024.101377

Age and gender mediated the association between anemia and 30-day outcomes in patients with ST-segment elevated myocardial infarction

Int J Cardiol Heart Vasc. 2024 Mar 2:51:101377. doi: 10.1016/j.ijcha.2024.101377. eCollection 2024 Apr.

Authors

Shan Wang^{1

2

3}, You Zhang^{1

2

3}, Datun Qi^{1

3}, Xianpei Wang^{1

3}, Zhongyu Zhu^{1

3}, Wei Yang^{1

3}, Muwei Li^{1

3}, Dayi Hu^{2

4}, Chuanyu Gao^{1

2

3}

Affiliations

¹ Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan, China.
² Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan, China.
³ Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China.
⁴ Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing, China.

Abstract

Background: The higher prevalence of anemia in females and elderly may be attributed to its association with worsened outcomes in ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the precise effects of age and gender on the association between anemia and 30-day outcomes.

Method: We identified 4350 STEMI patients and divided into anemia and non-anemia. Effects were analyzed as categories using Cox proportional-hazards regression and as continuous using restricted cubic splines. Propensity score matching (PSM) and mediation analysis were applied to identify intermediate effects.

Results: Anemic patients were older, more likely to be female, and experienced doubled all-cause death (7.3 % versus 15.0 %), main adverse cardiovascular and cerebrovascular events (MACCE, 11.1 % versus 20.2 %), heart failure (HF, 5.1 % versus 8.6 %), and bleeding events (2.7 % versus 5.4 %). After adjustment, the association between anemia and all-cause death (Hazard ratio (HR) 1.15, 95 % confidence interval (95 %CI) 0.93-1.14), MACCE (HR 1.14, 95 %CI 0.95-1.36) and HF (HR 1.19, 95 %CI 0.92-1.55) were insignificant, the effects persisted nullified across age classes (P-interaction > 0.05) and PSM (P > 0.05). Ulteriorly, age mediated 77.6 %, 66.2 %, 48.0 %, gender mediated 38.1 %, 15.0 %, 3.2 %, age and gender together mediated 99.8 % 72.9 %, 48.1 % of the relationship. Anemia was independently associated with bleeding events (HR 2.02, 95 %CI 1.42-2.88), the effects consisted significant regardless of PSM (P < 0.05), age, and gender classes (P-interaction > 0.05), and no mediating role of age and gender were observed.

Conclusions: In STEMI patients, age and gender largely mediated the relationship between anemia and all-cause death, MACCE, and HF, anemia was independently associated with bleeding complications.

Keywords: Age; Anemia; Gender; Mediation analysis; ST-elevation myocardial infarction.