Paul R Kalra1, Nicola Greenlaw2, Roberto Ferrari3, Ian Ford2, Jean-Claude Tardif4, Michal Tendera5, Christopher M Reid6, Nicolas Danchin7, Janina Stepinska8, Ph Gabriel Steg9, Kim M Fox10. 1. Portsmouth Hospital NHS Trust, Portsmouth and NHLI Imperial College, London, United Kingdom. Electronic address: paulkalra@doctors.org.uk. 2. Robertson Centre, University of Glasgow, Scotland. 3. Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care&Research, E.S: Health Science Foundation, Cotignola, Italy. 4. Montreal Heart Institute, Université de Montreal, Canada. 5. Medical University of Silesia, Katowice, Poland. 6. Curtin University, Western Australia & Monash University, Victoria, Australia. 7. Cardiology, European Hospital Georges-Pompidou, Paris, France. 8. Cardiology, Institute of Cardiology, Warsaw, Poland. 9. Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom. 10. NHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom.
Abstract
BACKGROUND: Anemia is a predictor of adverse outcomes in acute myocardial infarction. We studied the relationship of hemoglobin, or its change over time, and outcomes in patients with stable coronary artery disease. METHODS: The ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease is a prospective, cohort study of outpatients with stable coronary artery disease (32,901 in 45 countries 2009-2010): 21,829 with baseline hemoglobin levels. They were divided into hemoglobin quintiles and anemia status (anemic or normal at baseline/follow-up: normal/normal; anemic/normal; normal/anemic; anemic/anemic. All-cause mortality, cardiovascular events, and major bleeding at 4-year follow-up were assessed. RESULTS: Low baseline hemoglobin was an independent predictor of all-cause, cardiovascular, and noncardiovascular mortality, the composite of cardiovascular death/myocardial infarction or stroke and major bleeds (all P <.001; unadjusted models). Anemia at follow-up was independently associated with all-cause mortality (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.55-2.33 for anemic/anemic; 1.87; 1.54-2.28 for normal/anemic; both P <.001), noncardiovascular mortality (P <.001), and cardiovascular mortality (P = .001). Patients whose baseline anemia normalized (anemic/normal) were not at increased risk of death (HR, 1.02; 95% CI, 0.77-1.35), although the risk of major bleeding was greater (HR, 2.06; 95% CI, 1.23-3.44; P = .013) than in those with normal hemoglobin throughout. Sensitivity analyses excluding patients with heart failure and chronic kidney disease at baseline yielded qualitatively similar results. CONCLUSIONS: In this large population with stable coronary artery disease, low hemoglobin was an independent predictor of mortality, cardiovascular events, and major bleeds. Persisting or new-onset anemia is a powerful predictor of cardiovascular and noncardiovascular mortality.
BACKGROUND:Anemia is a predictor of adverse outcomes in acute myocardial infarction. We studied the relationship of hemoglobin, or its change over time, and outcomes in patients with stable coronary artery disease. METHODS: The ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease is a prospective, cohort study of outpatients with stable coronary artery disease (32,901 in 45 countries 2009-2010): 21,829 with baseline hemoglobin levels. They were divided into hemoglobin quintiles and anemia status (anemic or normal at baseline/follow-up: normal/normal; anemic/normal; normal/anemic; anemic/anemic. All-cause mortality, cardiovascular events, and major bleeding at 4-year follow-up were assessed. RESULTS: Low baseline hemoglobin was an independent predictor of all-cause, cardiovascular, and noncardiovascular mortality, the composite of cardiovascular death/myocardial infarction or stroke and major bleeds (all P <.001; unadjusted models). Anemia at follow-up was independently associated with all-cause mortality (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.55-2.33 for anemic/anemic; 1.87; 1.54-2.28 for normal/anemic; both P <.001), noncardiovascular mortality (P <.001), and cardiovascular mortality (P = .001). Patients whose baseline anemia normalized (anemic/normal) were not at increased risk of death (HR, 1.02; 95% CI, 0.77-1.35), although the risk of major bleeding was greater (HR, 2.06; 95% CI, 1.23-3.44; P = .013) than in those with normal hemoglobin throughout. Sensitivity analyses excluding patients with heart failure and chronic kidney disease at baseline yielded qualitatively similar results. CONCLUSIONS: In this large population with stable coronary artery disease, low hemoglobin was an independent predictor of mortality, cardiovascular events, and major bleeds. Persisting or new-onset anemia is a powerful predictor of cardiovascular and noncardiovascular mortality.
Authors: Katarzyna Wiechecka; Bartosz Wiechecki; Agnieszka Kapłon-Cieślicka; Agata Tymińska; Monika Budnik; Dominika Hołowaty; Krzysztof Jakubowski; Marcin Michalak; Elżbieta Świętoń; Przemysław Stolarz; Roman Steckiewicz; Marcin Grabowski; Piotr Scisło; Janusz Kochanowski; Krzysztof J Filipiak; Grzegorz Opolski Journal: Cardiol J Date: 2019-06-21 Impact factor: 2.737
Authors: Gyeongsil Lee; Seulggie Choi; Kyuwoong Kim; Jae-Moon Yun; Joung Sik Son; Su-Min Jeong; Sung Min Kim; Sang Min Park Journal: J Am Heart Assoc Date: 2018-01-29 Impact factor: 5.501