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Association of hemoglobin levels with clinical outcomes in acute coronary syndromes.
Circulation. 2005 Apr 26; 111(16):2042-9.Circ

Abstract

BACKGROUND

In the setting of an acute coronary syndrome (ACS), anemia has the potential to worsen myocardial ischemia; however, data relating anemia to clinical outcomes in ACS remain limited.

METHODS AND RESULTS

We examined the association between baseline hemoglobin values and major adverse cardiovascular events through 30 days in 39,922 patients enrolled in clinical trials of ACS. After adjustment for differences in baseline characteristics and index hospitalization treatments, a reverse J-shaped relationship between baseline hemoglobin values and major adverse cardiovascular events was observed. In patients with ST-elevation myocardial infarction, when those with hemoglobin values between 14 and 15 g/dL were used as the reference, cardiovascular mortality increased as hemoglobin levels fell below 14 g/dL, with an adjusted OR of 1.21 (95% CI 1.12 to 1.30, P<0.001) for each 1-g/dL decrement in hemoglobin. At the other end of the range of hemoglobin, patients with hemoglobin values >17 g/dL also had excess mortality (OR 1.79, 95% CI 1.18 to 2.71, P=0.007). In patients with non-ST-elevation ACS, with those with hemoglobin 15 to 16 g/dL used as the reference, the likelihood of cardiovascular death, myocardial infarction, or recurrent ischemia increased as the hemoglobin fell below 11 g/dL, with an adjusted OR of 1.45 (95% CI 1.33 to 1.58, P<0.001) for each 1 g/dL decrement in hemoglobin. Patients with hemoglobin values >16 g/dL also had an increased rate of death or ischemic events (OR 1.31, 95% CI 1.03 to 1.66, P=0.027).

CONCLUSIONS

Anemia is a powerful and independent predictor of major adverse cardiovascular events in patients across the spectrum of ACS.

Authors+Show Affiliations

TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA. msabatine@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15824203

Citation

Sabatine, Marc S., et al. "Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes." Circulation, vol. 111, no. 16, 2005, pp. 2042-9.
Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111(16):2042-9.
Sabatine, M. S., Morrow, D. A., Giugliano, R. P., Burton, P. B., Murphy, S. A., McCabe, C. H., Gibson, C. M., & Braunwald, E. (2005). Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation, 111(16), 2042-9.
Sabatine MS, et al. Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes. Circulation. 2005 Apr 26;111(16):2042-9. PubMed PMID: 15824203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. AU - Sabatine,Marc S, AU - Morrow,David A, AU - Giugliano,Robert P, AU - Burton,Paul B J, AU - Murphy,Sabina A, AU - McCabe,Carolyn H, AU - Gibson,C Michael, AU - Braunwald,Eugene, Y1 - 2005/04/11/ PY - 2005/4/13/pubmed PY - 2005/12/29/medline PY - 2005/4/13/entrez SP - 2042 EP - 9 JF - Circulation JO - Circulation VL - 111 IS - 16 N2 - BACKGROUND: In the setting of an acute coronary syndrome (ACS), anemia has the potential to worsen myocardial ischemia; however, data relating anemia to clinical outcomes in ACS remain limited. METHODS AND RESULTS: We examined the association between baseline hemoglobin values and major adverse cardiovascular events through 30 days in 39,922 patients enrolled in clinical trials of ACS. After adjustment for differences in baseline characteristics and index hospitalization treatments, a reverse J-shaped relationship between baseline hemoglobin values and major adverse cardiovascular events was observed. In patients with ST-elevation myocardial infarction, when those with hemoglobin values between 14 and 15 g/dL were used as the reference, cardiovascular mortality increased as hemoglobin levels fell below 14 g/dL, with an adjusted OR of 1.21 (95% CI 1.12 to 1.30, P<0.001) for each 1-g/dL decrement in hemoglobin. At the other end of the range of hemoglobin, patients with hemoglobin values >17 g/dL also had excess mortality (OR 1.79, 95% CI 1.18 to 2.71, P=0.007). In patients with non-ST-elevation ACS, with those with hemoglobin 15 to 16 g/dL used as the reference, the likelihood of cardiovascular death, myocardial infarction, or recurrent ischemia increased as the hemoglobin fell below 11 g/dL, with an adjusted OR of 1.45 (95% CI 1.33 to 1.58, P<0.001) for each 1 g/dL decrement in hemoglobin. Patients with hemoglobin values >16 g/dL also had an increased rate of death or ischemic events (OR 1.31, 95% CI 1.03 to 1.66, P=0.027). CONCLUSIONS: Anemia is a powerful and independent predictor of major adverse cardiovascular events in patients across the spectrum of ACS. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15824203/Association_of_hemoglobin_levels_with_clinical_outcomes_in_acute_coronary_syndromes_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000162477.70955.5F?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -