title: 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).
abstract: 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.
authors.affiliation: Department of Medicine, New York Methodist Hospital, Brooklyn, New York. Electronic address: sjb9005@nyp.org.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York; Department of Medicine, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York; Department of Medicine, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Edwin Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: Department of Medicine, HELIOS Amper-Klinikum Dachau, Dachau, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York.
authors.forename: Yiran
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York.
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: Center for Clinical Trials, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000628:therapy*; D000368:Aged; D000740:Anemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D000072658:Non-ST Elevated Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D015607:Stents; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D014218:Triage
chemical_list: D006454:Hemoglobins