Coronary artery disease
Usefulness of Anemia in Men as an Independent Predictor of Two-Year Cardiovascular Outcome in Patients Presenting With Acute Coronary Syndrome

https://doi.org/10.1016/j.amjcard.2006.03.031Get rights and content

Anemia has been shown to be an independent risk factor for the development of adverse cardiovascular outcomes in a variety of patient populations. In the case of patients presenting with acute coronary syndrome (ACS), anemia has been demonstrated to be a powerful and independent predictor of 30-day outcomes. However, there are limited and conflicting data about the long-term independent predictive value of anemia in patients with ACS. This is in contrast to non-ACS populations in which anemia has been shown to be an independent predictor of long-term outcomes. The present study investigated the long-term prognostic significance of anemia in a well-characterized cohort of 193 men with ACS who were referred for coronary angiography at a Veterans Affairs Medical Center. All patients were followed prospectively for the development of death or acute myocardial infarction (AMI), and follow-up data were available for all patients at 24 months. After controlling for a variety of baseline clinical, laboratory, and angiographic variables, hemoglobin (analyzed as a continuous variable and as a categorical variable using the World Health Organization cutoff of 13 g/dl for men) was a strong and independent predictor of the composite end point of death or AMI at 24 months when using a Cox proportional hazards model. At 24 months, the event-free survival was 64% in the group with a hemoglobin level <13 g/dl compared with 81% in the group with a hemoglobin level ≥13 g/dl (p = 0.0065 by log-rank test). In conclusion, these data demonstrate that baseline anemia is a strong and independent predictor of death or AMI at 2 years in patients with ACS.

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Methods and Results

This study was conducted at a Veterans Administration Medical Center and was approved by the local institutional review board. Written informed consent was obtained from all patients. Between January 1999 and October 2002, 193 men who underwent diagnostic coronary angiography for the evaluation of ACS were enrolled in the study. Patients with active gastrointestinal bleeding were excluded from the study. Three groups of patients were categorized by type of ACS. (1) The group with ST-elevation

Discussion

In a broad cohort of patients with ACS, we found a strong and statistically significant independent association between low hemoglobin concentrations and the adverse cardiovascular outcomes of death and AMI at 24 months. Although there are compelling data relating anemia to short-term clinical outcomes in ACS,4 data for long-term outcomes are limited and conflicting. For example, in a study that examined a database of discharge abstract information in patients admitted with AMI, those

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