Anemia as independent predictor of major events in elderly patients with chronic angina.
BACKGROUND
Anemia correlates with worse outcome in patients with heart failure, after myocardial infarction or angioplasty. Its prevalence increases with age, but the influence of anemia on outcome of elderly patients with stable symptomatic coronary artery disease (CAD) is unknown. Therefore, we assessed the impact of anemia on long-term outcome in elderly patients with CAD.


METHODS
Hemoglobin-related outcome was examined in 253 patients of the TIME study. Patients > or = 75 years old were randomly assigned to an invasive or optimized medical strategy and followed for a median of 4 years for death, nonfatal myocardial infarction, or hospitalization for CAD. Depending on their hemoglobin (Hb) level, patients were divided in quartiles (Q). Anemia was defined as Hb < 13 g/dL for men and < 12 g/dL for women.


RESULTS
Compared with nonanemic patients, those with previously unknown anemia were older (79 +/- 3 vs 80 +/- 4 years, P < .01), had more chronic renal failure (6.7% vs 26.4%, P < .01), diabetes (18.9% vs 30.1%, P = .05), and were more likely to have > 2 comorbidities (21.7% vs 38.4%, P < .01). After adjustment for baseline differences, a decrease in 1 g/dL Hb increased the risk of all-cause death by 34% (adjusted risk ratio 1.34, P < .01), of cardiac death by 28% (adjusted risk ratio 1.28, P = .02), and of major adverse clinical events in patients with Hb levels < 13.3 g/dL by 23% (adjusted risk ratio 1.23, P = .01).


CONCLUSIONS
Anemia proved to be an independent predictor of death and major clinical adverse events among elderly patients with stable symptomatic CAD.
Muzzarelli
Stefano
S
Division of Cardiology, University Hospital, Basel, Switzerland.
Pfisterer
Matthias
M
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D006454:Hemoglobins