title: Hemoglobin Level Adds Prognostic Value to the Global Registry of Acute Coronary Events Score in Non-ST Elevation Acute Coronary Syndromes.
abstract: OBJECTIVE
  We aimed to test the hypothesis that hemoglobin values add prognostic information to the Global Registry of Acute Coronary Events (GRACE) score at admission in patients with non-ST elevation acute coronary syndromes (ACS).
  
  
  METHODS
  A total of 225 consecutive patients with non-ST elevation ACS were studied. Hemoglobin was measured at admission, and its prognostic value was evaluated in relation to cardiovascular events during hospitalization, defined as the composite of death or myocardial infarction.
  
  
  RESULTS
  The incidence of major in-hospital events was 7% (10 deaths and 5 nonfatal myocardial infarctions). Hemoglobin significantly predicted events, with a C statistic of 0.67 [95% confidence interval (CI) 0.53-0.81; p = 0.03], with 12.1 g/dl as the cutoff point of best performance. After adjustment for the GRACE score, low hemoglobin (≤12.1 g/dl) remained an independent predictor of events (odds ratio 3.9, 95% CI 1.2-13; p = 0.028). The C statistic of the GRACE score for prediction of events improved from 0.80 to 0.84 after hemoglobin was taken into account. Finally, the addition of hemoglobin to the GRACE score promoted a net reclassification improvement of 16% in identifying high-risk patients (p = 0.025).
  
  
  CONCLUSIONS
  The present study provides preliminary evidence that hemoglobin level independently predicts recurrent events during hospitalization and improves the prognostic performance of the GRACE score in patients with non-ST elevation ACS.
authors.affiliation: Medical School of Bahia, Salvador, Brazil.
authors.forename: Luis C L
authors.initials: LC
authors.lastname: Correia
authors.forename: Alexandre C
authors.initials: AC
authors.lastname: Souza
authors.forename: Michael
authors.initials: M
authors.lastname: Sabino
authors.forename: Mariana
authors.initials: M
authors.lastname: Brito
authors.forename: Mayara
authors.initials: M
authors.lastname: Maraux
authors.forename: Guilherme
authors.initials: G
authors.lastname: Garcia
authors.forename: J Péricles
authors.initials: JP
authors.lastname: Esteves
authors.forename: Márcia M
authors.initials: MM
authors.lastname: Noya-Rabelo
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D006454:Hemoglobins; D019210:Troponin I; D020107:Troponin T