Relation of Anemia at Discharge to Survival After Acute Coronary Syndromes

Vaglio, Joseph C.; Safley, David M.; Rahman, Mohamed Abdel; Kosiborod, Mikhail; Jones, Philip G.; Thompson, Randall C.; Krumholz, Harlan M.; Spertus, John A.

doi:10.1016/j.amjcard.2005.04.008

Cited by 40 publications

(35 citation statements)

References 7 publications

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“…This association remains significant after adjustment for other risk markers that could be related to anemia, such as age and renal impairment [3,12,13,14,15,16,17,18]. However, statistical significance in multivariate analysis is not a sufficient condition for a clinically relevant improvement in prognostic assessment.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin Level Adds Prognostic Value to the Global Registry of Acute Coronary Events Score in Non-ST Elevation Acute Coronary Syndromes

Correia¹,

Souza²,

Sabino³

et al. 2012

Cardiology

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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.

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Section: Discussionmentioning

confidence: 99%

Hemoglobin Level Adds Prognostic Value to the Global Registry of Acute Coronary Events Score in Non-ST Elevation Acute Coronary Syndromes

Correia¹,

Souza²,

Sabino³

et al. 2012

Cardiology

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“…Clinically significant anemia accompanies a variety of illnesses characterized by acute or chronic immune activation, including cancer, cardiac disease, autoimmunity, and infection (14,22,25). During life-threatening illnesses, anemia often correlates with an increased risk of early death (2,9,16,23).…”

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confidence: 99%

Gamma Interferon Suppresses Erythropoiesis via Interleukin-15

et al. 2007

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Impaired erythropoiesis causes anemia during genetic disorders, chronic disease, and infection. In studies of the underlying mechanisms researchers have increasingly focused on gamma interferon (IFN-␥). Here, we identified a previously unrecognized role for interleukin-15 (IL-15) in red blood cell homeostasis and demonstrated that IFN-␥ and signal transducer and activator of transcription protein 1-dependent pathways upregulate expression of IL-15 in vivo. These findings identified new therapeutic targets for anemia.

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“…18 -20 To our knowledge, only 1 other study has clearly examined the association between survival and anemia at discharge. 4 After multivariable adjustment, Vaglio et al 4 found that discharge anemia was significantly associated with higher 2-y mortality, while admission anemia was not. In the current study, after multivariable adjustment, we found that the associations between anemia and higher 6-mo and 1-y mortality were significantly attenuated.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia was defined categorically as hemoglobin <11 g/dL. 3,4 Finally, healthrelated quality of life assessments were conducted by trained interviewers for all patients at baseline (24 h from cardiac catheterization), 6 mo, and 1 y using the validated Medical Outcomes Study Short-form 36 (SF-36). 9 Physical function was assessed by self-report using the SF-36 PF subscale in which higher scores indicate better health (scale 0-100).…”

Section: Methodsmentioning

confidence: 99%

“…In patients with acute coronary syndromes, admission hemoglobin levels <11 g/dL have been associated with increased risk of death and ischemic complications at 30 d. 3,5 This same hemoglobin threshold at discharge continues to predict worse all-cause mortality over the subsequent 2 y. 4 Many therapies used during hospitalization for acute coronary syndromes are associated with increased risk of bleeding, so anemia is likely to develop or worsen in this setting. 6,7 As a result, patients with anemia at discharge may be different than those with anemia at the time of admission.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Anemia on Physical Function and Survival Among Patients with Coronary Artery Disease

Patel¹,

Grab²,

Kosiborod³

et al. 2008

Clinical Cardiology

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Background: Anemia is a purported risk factor for adverse outcomes, particularly among patients with cardiac disease. Although anemia at the time of discharge has been associated with poor functional status and survival, its impact over time is not clear. Hypothesis: Among patients with significant coronary artery disease (CAD), anemia (hemoglobin <11 g/dL) is prevalent, and is associated with poor physical function (PF) and survival over time. Methods: Patients with significant CAD at the time of cardiac catheterization (n = 1,821) were enrolled into a single-center, observational, and prospective study. All patients were followed for up to 1 y for clinical events and self-reported PF. Prevalence of anemia at discharge and its' associations with outcomes over time were examined. Results: Anemia at the time of discharge was very common (40.4%), and was associated with increased odds of death at 12 mo (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.12-2.15), yet other clinical factors accompanying anemia accounted for this association (adjusted OR 1.13, 95% CI 0.79-1.62). Discharge anemia was also associated with significantly lower self-reported PF at 6 and 12 mo (p<0.05 for both); however, other clinical factors accompanying anemia also accounted for these associations. Conclusions: Although discharge anemia is highly prevalent, its association with adverse outcomes is largely explained by baseline patient characteristics. Further research is needed to clarify the relationship between anemia and outcomes in this population and to identify subpopulations that do not recover independently and for whom available therapies may be beneficial.

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Relation of Anemia at Discharge to Survival After Acute Coronary Syndromes

Cited by 40 publications

References 7 publications

Hemoglobin Level Adds Prognostic Value to the Global Registry of Acute Coronary Events Score in Non-ST Elevation Acute Coronary Syndromes

Hemoglobin Level Adds Prognostic Value to the Global Registry of Acute Coronary Events Score in Non-ST Elevation Acute Coronary Syndromes

Gamma Interferon Suppresses Erythropoiesis via Interleukin-15

Impact of Anemia on Physical Function and Survival Among Patients with Coronary Artery Disease

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