title: Hemoglobin nonrecovery following acute myocardial infarction is a biomarker of poor outcome: a retrospective database study.
abstract: BACKGROUND
  Anemia on admission and during hospitalization is associated with poor short and long term prognosis among patients with acute coronary syndrome (ACS). Our objective was to examine the prognostic implications of longitudinal hemoglobin (Hb) levels following a first acute myocardial infarction (AMI).
  
  
  METHODS
  We utilized data obtained from the computerized database of a large community based health care maintenance organization to identify patients who survived for at least 6 months following a first AMI, during the years 2003-2010. Hazard ratios were calculated using Cox proportional regression models with various Hb measurements as dependent variables, and net reclassification improvement (NRI) was applied to evaluate the prognostic usefulness of these Hb measurements.
  
  
  RESULTS
  Last Hb measurement during a 6-24 month follow-up period was found to have the highest prognostic power. In males, Hb levels below 13 g/dL were gradually associated with a higher risk of events, reaching a HR of 4.13 at Hb levels <11 g/dL. In females, only Hb levels lower than 11 g/dL were significantly associated with a higher event rate (HR=2.42, p=0.003). Hb decrease was significantly associated with an increased risk in both genders, even among non-anemic patients at baseline.
  
  
  CONCLUSIONS
  Anemia and Hb decrement following a first AMI are associated with worse prognosis and elevated risk of combined all cause mortality and recurrent cardiac events.
authors.affiliation: Departments of Medicine "D" and "E", Tel-Aviv Sourasky Medical Center; and Sackler faculty of medicine, Tel-Aviv University, Tel Aviv, Israel. Electronic address: dr.eranleshem@gmail.com.
authors.forename: Eran
authors.initials: E
authors.lastname: Leshem-Rubinow
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
authors.forename: David
authors.initials: D
authors.lastname: Zeltser
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.forename: Dahlia
authors.initials: D
authors.lastname: Weitzman
authors.forename: Raanan
authors.initials: R
authors.lastname: Raz
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: ACS; AMI; Acute myocardial infarction; Anemia; CABG; CI; HMO; HR; Hb; Hemoglobin; NRI; PCI; acute coronary syndromes; acute myocardial infarction; confidence intervals; coronary artery bypass grafting; eGFR; estimated glomerular filtration rate; hazard ratios; health care maintenance organization; hemoglobin; net reclassification index; percutaneous coronary intervention