Journal Article

Relation of Baseline Hemoglobin Levels and Adverse Events in Patients With Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage strategY and Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction Trials)

Dangas, George D., Brener, Sorin J., Parvataneni, Rupa, Ohman, Edwin Magnus, Zhang, Yiran, Stone, Gregg W., Witzenbichler, Bernhard, Mehran, Roxana

2017

Overview

The association between anemia at admission and adverse outcomes in patients with acute coronary syndrome (ACS) has been incompletely studied. Anemia was defined as serum hemoglobin <12 g/dl in women or <13 g/dl in men in 2 large trials of patients with ACS. We plotted hazard functions for major bleeding at 30 days and all-cause mortality, myocardial infarction, and stent thrombosis at 1 year according to baseline hemoglobin. Among 16,318 patients, 3070 (18.8%) had anemia at baseline. All-cause death at 1 year (2.9% vs 1.5%), major bleeding (7.6% vs 3.6%, p <0.001), and transfusions (6.7% vs 1.5%, p <0.001) were more common in patients with baseline anemia. Spline transformations of the hazard for adverse events as a function of hemoglobin level on admission showed that adverse outcomes increased in a nonlinear fashion with lower levels of baseline hemoglobin; the lowest rates were observed at a level of ∼14 g/dl. Baseline hemoglobin and anemia were independent predictors of major bleeding and death. In conclusion, in patients with ACS, baseline hemoglobin carries important independent prognostic information and demonstrates a nonlinear association with major bleeding and mortality.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Coronary Syndrome - blood / Acute Coronary Syndrome - complications / Acute Coronary Syndrome - therapy / Acute coronary syndromes / Aged / Anemia / Anemia - blood / Anemia - complications / Anemia - epidemiology / Angina pectoris / Bleeding / Blood / Cardiac Catheterization / Cardiovascular / Cardiovascular disease / Catheterization / Cause of Death - trends / Clinical outcomes / Clinical trials / Coronary Angiography / Coronary vessels / Critical care / Diabetes / Disorders / Electrocardiography / Female / Health risk assessment / Heart attacks / Hemoglobin / Hemoglobins - metabolism / Humans / Implants / Incidence / Intervention / Intubation / Male / Medical imaging / Men / Middle Aged / Mortality / Myocardial infarction / New York - epidemiology / Non-ST Elevated Myocardial Infarction - epidemiology / Non-ST Elevated Myocardial Infarction - etiology / Non-ST Elevated Myocardial Infarction - therapy / Patients / Percutaneous Coronary Intervention - methods / Prognosis / Stents / Surgical implants / Survival Rate - trends / Thrombolytic Therapy - methods / Thrombosis / Transformations (mathematics) / Triage