Relation of Baseline Hemoglobin Levels and Adverse Events in Patients with Acute Coronary Syndromes (from the ACUITY and HORIZONS-AMI Trials)

Research paper by Sorin J. Brener, Roxana Mehran, George D. Dangas, E. Magnus Ohman, Bernhard Witzenbichler, Yiran Zhang, Rupa Parvataneni, Gregg W. Stone

Indexed on: 22 Mar '17Published on: 16 Mar '17Published in: The American Journal of Cardiology®


The association between anemia at admission and adverse outcomes in patients with acute coronary syndromes (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 acute coronary syndromes. 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% versus 3.6%, p<0.001), and transfusions (6.7% versus 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 non-linear 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 non-linear association with major bleeding and mortality.

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