Coronary Artery DiseaseRelation 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)
Section snippets
Methods
The design and results of the ACUITY and HORIZONS-AMI trials have been previously reported in detail.5, 6, 7 In brief, in ACUITY, 13,819 patients with non–ST-segment elevation ACS (NSTE-ACS) were randomized to 1 of the 3 antithrombotic regimes: bivalirudin alone, bivalirudin with a glycoprotein IIb/IIIa inhibitor, or heparin with a glycoprotein IIb/IIIa inhibitor. All patients underwent coronary angiography within 72 hours, after which the decision for revascularization was left to the
Results
Among 16,318 patients with complete data, 3,070 (18.8%) had anemia at baseline. Baseline and procedural characteristics according to the presence of anemia at presentation are listed in Table 1. Patients with anemia were older, more often women, and more likely to have concomitant risk factors for coronary artery disease. They were also significantly less likely to undergo revascularization. The hemoglobin level on admission was 12.0 ± 1.1 in anemic patients and 14.6 ± 1.2 in nonanemic patients
Discussion
The principal findings from the present study of more than 16,000 patients with ACS from 2 international randomized trials are as follows: (1) a nonlinear relation was present among baseline hemoglobin as a continuous variable and both 30-day major bleeding and 1-year adverse ischemic outcomes, with increasing event rates at low hemoglobin levels and a nadir at approximately 14 g/dl; (2) in contrast to patients with higher baseline hemoglobin levels, much of the excess of non-CABG major
Disclosures
Roxana Mehran and George D. Dangas receive research grant support from Eli Lilly, AstraZeneca, The Medicines Company, BMS/Sanofi-Aventis, DSI, and OrbusNeich; are a consultant for AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals Inc., Merck & Co., Osprey Medical Inc., and Watermark Research Partners; and are on the scientific advisory board of Abbott Laboratories, Boston Scientific Corporation, Covidien, Janssen Pharmaceuticals, The Medicines Company, and Sanofi-Aventis. Edwin Magnus
References (18)
- et al.
A risk score to predict bleeding in patients with acute coronary syndromes
J Am Coll Cardiol
(2010) - et al.
Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial)
Am J Cardiol
(2014) - et al.
Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial
J Am Coll Cardiol
(2004) - et al.
Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale
Am Heart J
(2004) - et al.
Incidence, prognostic impact, and influence of antithrombotic therapy on access and nonaccess site bleeding in percutaneous coronary intervention
JACC Cardiovasc Interv
(2011) - et al.
Hemoglobin level and hospital mortality among ICU patients with cardiac disease who received transfusions
J Am Coll Cardiol
(2015) - et al.
Potentiation by red blood cells of shear-induced platelet aggregation: relative importance of chemical and physical mechanisms
Blood
(1984) - et al.
Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes
Eur Heart J
(2010) - et al.
Bivalirudin for patients with acute coronary syndromes
N Engl J Med
(2006)
Cited by (37)
Haemoglobin levels as a predictor for the occurrence of future cardiovascular events in adults–Sex-dependent results from the EPIC trial
2023, European Journal of Internal MedicineAnaemia and acute coronary syndrome: A complex clinical scenario
2022, Medicina ClinicaCitation Excerpt :In ACS, the prevalence of anaemia has been showed to be from 10% to 30%,6 being much more higher in ACS than in general population, where it just reaches almost 4%.7 Its presence has been identified as an independent predictor of adverse outcomes at short and long term follow-up in ACS.6,7 However, the use of blood transfusions as a generalized treatment for anaemia has been related to a worse prognosis, with an unclear role.
Does atrial fibrillation ablation worsen preexisting anemia? Another anemia paradox in DOAC era
2021, Journal of CardiologyCitation Excerpt :Would the present study be “heretical”? There are three studies with a large number of participants that reported similar findings to ours [19–21], where subjects with anemia at baseline had a smaller hemoglobin drop following coronary or peripheral vascular interventions compared to those without. The authors did not provide any comments on this paradoxical finding, though.
Very short dual antiplatelet therapy after PCI and new DES: a meta-analysis of 5 randomized trials
2021, Revista Espanola de Cardiologia
See page 1715 for disclosure information.