title: Anemia is an independent risk for mortality after acute myocardial infarction in patients with and without diabetes.
abstract: BACKGROUND
  Anemia and diabetes are risk factors for short-term mortality following an acute myocardial infarction(AMI). Anemia is more prevalent in patients with diabetes. We performed a retrospective study to assess the impact of the combination of diabetes and anemia on post-myocardial infarction outcomes.
  
  
  METHODS
  Data relating to all consecutive patients hospitalized with AMI was obtained from a population-based disease-specific registry. Patients were divided into 4 groups: diabetes and anemia (group A, n = 716), diabetes and no anemia (group B, n = 1894), no diabetes and anemia (group C, n = 869), and no diabetes and no anemia (group D, n = 3987). Mortality at 30 days and 31 days to 36 months were the main outcome measures.
  
  
  RESULTS
  30-day mortality was 32.3% in group A, 16.1% in group B, 21.5% in group C, 6.6% in group D (all p < 0.001). 31-day to 36-month mortality was 47.6% in group A, 20.8% in group B, 34.3% in group C, and 10.4% in group D (all p < 0.001). Diabetes and anemia remained independent risk factors for mortality with odds ratios of 1.61 (1.41-1.85, p < 0.001) and 1.59 (1.38-1.85, p < 0.001) respectively at 36 months. Cardiovascular death from 31-days to 36-months was 43.7% of deaths in group A, 54.1% in group B, 47.0% in group C, 50.8% group D (A vs B, p < 0.05).
  
  
  CONCLUSIONS
  Patients with both diabetes and anemia have a significantly higher mortality than those with either diabetes or anemia alone. Cardiovascular death remained the most likely cause of mortality in all groups.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Canada. shu.dave@gmail.com
authors.forename: David H
authors.initials: DH
authors.lastname: Shu
authors.forename: Thomas P P
authors.initials: TP
authors.lastname: Ransom
authors.forename: Colleen M
authors.initials: CM
authors.lastname: O'Connell
authors.forename: Jafna L
authors.initials: JL
authors.lastname: Cox
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Kaiser
authors.forename: Shirl A
authors.initials: SA
authors.lastname: Gee
authors.forename: Richard C
authors.initials: RC
authors.lastname: Rowe
authors.forename: Ehud
authors.initials: E
authors.lastname: Ur
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Imran
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D015897:Comorbidity; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality*; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate