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Incidence of NSTEMI versus STEMI in patients with hemorrhage and/or anemia

Introduction. Hemorrhage and anemia cause hypoperfusion and decreased oxigenation of body organs including heart. There is evidence that anemia is a condition recognized as an independent risk for the progression of cardiovascular disease and for mortality after acute myocardial infarction. We supposed that in nonselective group of patients with hemorrhage and/or anemia we could expected more often NSTEMI than STEMI. Methods. We retrospectively analyzed data of 34 patients with hemorrhage and subsequently development of acute myocardial infarction or with severe anemia and concomitant myocardial infarction without signs or data of recent hemorrhage treated in the Intensive Care Unit, Department of Internal Medicine, Dubrava University Hospital from January 2000 to May 2005. Results. All included were Caucasian, 19 males (55.9%) AND 15 (44.1%) FEMALES. Age of patients were between 51 and 94 years (median 73.21 years, SD 11.84). In 25 patients (76.5%) we verified a bleeding from upper part and in 4 (11.8%) from lower part of gastrointestinal tract, two patients (5.9%) had a chronic anemia, in one (2.9%) we found hematuria and one had hemorrhagic pancreatic pseudocyst. The lowest haemoglobin concentration ranged from 36 to 110 g/l (median 69.53 g/l, SD 19.7). Mean APACHE II score was 14.09+/-6.708 (minimal 4, maximal 36). NSTEMI development in 31 pts (91%) while STEMI was present in 3 patients (8.8%). Among NSTEMI patients, 27 (79.4%) had electrocardiographic (ECG) signs of ischemia, 3 (8.8%) had left bundle branch block and one patient (2.9%) with chest pain without ECG changes had increased specific markers of cardiac injury (CK, CK-MB, troponin I). Seven patients, all with NSTEMI, died (20.6%). Conclusion. Anemia can worsening oxygen supplying of myocardial areas with previosly insufficient blood supply causing critical ischemia and severe cases tissue death-necrosis or infarction of subendocardium or diffuse. Today confirmation of myocardial damage can be easily obtained by definite marker like troponin I, which are highly specific and sensitive. In addition we can expected ECG changes related NSTEMI with increasing frequency in anemia and hemorrhage.

hemorrhage; anemia; myocardial infarction

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