Beyond Anemia, Iron deficiency in Acute Coronary Syndrome: Clinical and Angiographic profile and In hospital Outcomes in a Tertiary Hospital in Eastern Nepal

Abstract

BACKGROUND Iron, being important enzymatic cofactor for mitochondrial function, essential in cellular oxygen metabolism and mitochondrial function, it deficiency may lead  to myocardial ischemia–reperfusion injury and may exacerbate myocardial damage in Acute Coronary Syndrome (ACS)  and has been linked with onset, progression and severity and appears to influence clinical outcomes.

AIMS This study aimed to describe the association of iron deficiency with clinical characteristics, severity and outcomes among ACS patients in a tertiary tropical hospital in Nepal.

METHODS This was a descriptive cross-sectional study where clinical and angiographic profile of patients presenting with ACS, admitted in BPKIHS between January 2024 and December 2024 were evaluated and analysed in relation to Iron deficiency and anemia. Statistical analysis was done using SPSS 23.

RESULTS A total of 183 patients with ACS admitted in the study period were included in the study. Prevalance of iron deficiency and anemia was found to be 43.17%  and 45.35% respectively. Iron deficiency in ACS didn’t show significant association with age, gender,traditional like Diabetes, Hypertension, dyslipidemia and family history  or Type of ACS. Iron deficieny  showed significant association with anemia (p <0.001), Killip Class (p 0.0946) and severity of Coronary artery disease in terms of Gensini Score (p 0.01). However iron deficiency was not found to have significantly association with  with vessel score (0.06), CCU stay (p 0.126) or Hospital stay (p<0.219). Iron deficiency had significant association with Total adverse outcomes (p<0.001) and nonfatal outcome (p <0.001), irrespective of anemia, but no significant association was found with mortality. (p 0.441). 

Conclusions Iron deficiency were associated with higher severity of the ACS and in hospital adverse outcomes including higher non fatal adverse outcomes. Early stratification of disease based on biomarkers can guide early intervention to prevent bad outcomes