The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

Q: What are the key findings of this study?

Both low and high serum ferritin levels were associated with higher in-hospital and 30-day mortality, LVEF decline, and left ventricular aneurysm formation in AMI patients across 7 studies.

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acute myocardial infarction (AMI). Intervention: Abnormal serum ferritin levels (low or high) vs. Normal or intermediary serum ferritin levels. Primary outcome: Adverse cardiovascular outcomes (mortality, MACE, LVEF decline, and left ventricular aneurysm development).

Q: What does this research mean for the field?

Both low and high serum ferritin levels are associated with increased risk of adverse outcomes, including mortality, LVEF decline, and left ventricular aneurysm formation, in patients with acute myocardial infarction. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Crischentian Brinza; Mariana Floria; Iolanda Valentina Popa; Alexandru Burlacu

doi:10.3390/diagnostics12020476

February 13, 2022DiagnosticsOpen Access

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

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Key result

Abnormal ferritin levels are linked to higher short-term mortality and adverse LV remodeling after AMI.

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Why the study?

Ferritin is associated with adverse outcomes in various pathological conditions, but no systematic review had evaluated the association between ferritin levels and adverse cardiovascular outcomes in patients with AMI.

Does serum ferritin evaluation predict adverse cardiovascular outcomes in patients with acute myocardial infarction?

Key Points

To evaluate the association between serum ferritin concentrations and adverse cardiovascular outcomes during short- or long-term follow-up in patients with acute myocardial infarction.
Systematic review conducted following PRISMA guidelines across MEDLINE, Embase, Cochrane, and Google Scholar from database inception until November 1, 2021.
Methodological quality was assessed using the Newcastle-Ottawa scale for cohort/case-control studies and the NIH quality assessment tool for uncontrolled studies.
In individual cohorts, low ferritin was associated with higher risk of 30-day MACE (p=0.01; AUC=0.65, p=0.001), while high ferritin (>220 ng/mL) was associated with higher in-hospital mortality (n=5 vs n=1 low and n=2 intermediary, p=0.03).
High ferritin levels were linked to significantly lower baseline LVEF (<35% vs 35%–50%, p=0.002) and an accentuated decline in LVEF at 6 months (>200 ng/mL vs <100 ng/mL, p<0.01; vs 100–200 ng/mL, p<0.05).
Both low and high ferritin values were independently associated with left ventricular aneurysm formation (p=0.042) and correlated with total duration of hospitalization (p=0.01).

Study Design

Type

Systematic Review

Structured PICO

Does serum ferritin evaluation predict adverse cardiovascular outcomes in patients with acute myocardial infarction?

P

Population

Adult patients (aged ≥18 years) presenting with acute myocardial infarction (STEMI or NSTEMI) across 7 non-randomized observational studies, followed from in-hospital stay up to 6 months.

E

Exposure

Serum ferritin evaluation (exposure to low or high serum ferritin concentrations)

C

Comparator

Normal or intermediary serum ferritin levels

O

Outcome

Adverse cardiovascular outcomes including in-hospital and 30-day mortality, major adverse cardiovascular events (MACE), decline of left ventricular ejection fraction (LVEF), and left ventricular aneurysm (LVA) development from in-hospital stay up to 6 months follow-up.composite

Both low and elevated serum ferritin levels are associated with increased mortality, LVEF decline, and left ventricular aneurysm formation after acute myocardial infarction, suggesting ferritin could aid in clinical risk stratification.

Limitations

Data inhomogeneity hampered the possibility to conduct a meta-analysis due to different effect measures across studies.
Small population size in the included studies limits the generalizability of the results.
No consensus exists on the cut-off ferritin values across studies.
Most clinical studies focused on a single ferritin assessment rather than serial measurements.
All 7 included studies had a non-randomized observational design with fair to low quality.
Data inhomogeneity hampered the possibility to conduct a meta-analysis.
Small sample size of the included populations limits generalizability.
Lack of consensus on cut-off ferritin values across studies.
Reliance on a single ferritin assessment rather than serial measurements.
Observational design of all included studies with fair to low quality.

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Implication

Ferritin may aid AMI risk stratification; hypothesis-generating from observational data and requires prospective validation before practice change.

Abstract

The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI.

Discussion

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Cite This Study

Brinza et al. (2022) conducted a systematic review in Acute myocardial infarction (AMI). Abnormal serum ferritin levels (low or high) vs. Normal or intermediary serum ferritin levels was evaluated on Adverse cardiovascular outcomes (mortality, MACE, LVEF decline, and left ventricular aneurysm development). Both low and high serum ferritin levels were associated with higher in-hospital and 30-day mortality, LVEF decline, and left ventricular aneurysm formation in AMI patients across 7 studies.

synapsesocial.com/papers/6a9180f2ff058589c6f142c6 https://doi.org/10.3390/diagnostics12020476

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The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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