PTH-023 The incidence & investigation of iron deficiency anaemia in patients presenting with acute coronary syndrome

Introduction Co-presentation with anaemia and acute coronary syndrome (ACS) is common. Anaemia is an independent risk factor for poor outcomes after ACS. Bleeding is the most common non-cardiac complication of ACS therapy. There are few studies existing on these patients. In this retrospective study we reported the incidence and characteristics of anaemia in patients presenting with NSTEMI (n=55) or STEMI (n=58) between 2015 and 2016 to a large tertiary centre. Methods Patients were identified using an ICD10 code-based search. Data were collected from electronic patient notes and the pathology system. Endoscopy reports one year prior to and after the ACS were reviewed. Results 45% patients with NSTEMI and 28% STEMI were anaemic at presentation with ACS. This was a microcytic anaemia in 36% patients. Iron saturations were tested or a recent result was available in 29% patients and ferritin was tested in 19% patients. These tests were more frequently performed in patients who had NSTEMI. When tested, iron saturations were low in 76% patients and ferritin was low in 29%. Only a minority of patients had endoscopic investigations for anaemia (table 1). Significant findings (ulcers, active bleeding or cancer) were found at 28% gastroscopy more commonly in patients with STEMI (45%). Significant findings (polpys, cancer, proctitis) were found at 32% lower GI investigations. No endoscopic complications occurred. 69% STEMI and 27% NSTEMI patients had coronary stenting. 81% patients were discharged on dual antiplatelet therapy and 16% on anti-coagulation. 1-year outcome data were available for 99/113. Crude mortality was 24%. 7.1% patients developed overt GI bleeding during admission or in the year after ACS. Conclusions Anaemia is common in patients presenting with ACS. Adequate gastrointestinal investigations were only performed on a minority of these patients but when completed showed a high incidence of iron deficiency and important findings at endoscopy. This patient group has a significant risk of both bleeding and ischaemia and could benefit from complete investigation of their anaemia.