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Anaemia to predict outcome in patients with acute coronary syndromes
Pierre Vladimir Ennezat1, Sylvestre Maréchaux, Claire Pinçon
1Cardiology Intensive Care Unit, CHRU Lille and Institut Fédératif de Recherche 114, EA 2693, Université de Lille 2UDSL, France. ennezat@yahoo.com
Insights
Anemia independently predicts outcomes in acute coronary syndromes (ACS) and refines the GRACE risk score. This combination improves risk prediction, often correcting for overestimation in the GRACE score alone.
Area of Science:
- Cardiology
- Clinical Risk Stratification
Background:
- Acute coronary syndromes (ACS) require risk stratification for optimal management.
- The GRACE risk score is a standard tool for assessing ACS patient risk.
- Patient heterogeneity in ACS necessitates refined risk assessment tools.
Purpose of the Study:
- To determine if anemia improves the predictive accuracy of the GRACE risk score in ACS patients.
- To evaluate the impact of anemia on midterm outcomes following ACS.
Main Methods:
- A prospective registry of 1064 ACS patients was analyzed.
- Anemia was defined by specific hemoglobin levels in men and women.
- The primary endpoint was a composite of death or rehospitalization for myocardial infarction (MI) at 6 months.
Main Results:
- Anemia was independently associated with adverse clinical outcomes in ACS patients (HR 2.870).
- Adding anemia to the GRACE score significantly improved model fit and discrimination (c-statistic increased from 0.633 to 0.697).
- Combining anemia with the GRACE score led to substantial reclassification of patient risk categories.
Conclusions:
- Anemia provides independent prognostic information beyond the GRACE risk score.
- Integrating anemia into the GRACE score enhances its predictive value for ACS outcomes.
- The combined model offers a more accurate risk assessment, addressing GRACE score overestimation.
Background:
Owing to the heterogeneous population of patients with acute coronary syndromes (ACS), risk stratification with tools such as the GRACE risk score is recommended to guide therapeutic management and improve outcome.
Aim:
To evaluate whether anaemia refines the value of the GRACE risk model to predict midterm outcome after an ACS.
Methods:
A prospective registry of 1064 ACS patients (63 ± 14 years; 73% men; 57% ST-segment elevation myocardial infarction [MI]) was studied. Anaemia was defined as haemoglobin less than 13 mg/dL in men or less than 12 mg/dL in women. The primary endpoint was 6-month death or rehospitalization for MI.
Results:
The primary endpoint was reached in 132 patients, including 68 deaths. Anaemia was associated with adverse clinical outcomes (hazard ratio 3.008, 95% confidence interval 2.137-4.234; P<0.0001) in univariate analysis and remained independently associated with outcome after adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score (hazard ratio 2.870, 95% confidence interval 1.815-4.538; P<0.0001). Anaemia provided additional prognostic information to the GRACE score as demonstrated by a systematic improvement in global model fit and discrimination (c-statistic increasing from 0.633 [0.571;0.696] to 0.697 [0.638;0.755]). Subsequently, adding anaemia to the GRACE score led to reclassification of 595 patients into different risk categories; 16.5% patients at low risk (≤ 5% risk of death or rehospitalization for MI) were upgraded to intermediate (>5-10%) or high risk (>10%); 79.5% patients at intermediate risk were reclassified as low (55%) or high risk (24%); and 45.5% patients at high risk were downgraded to intermediate risk. Overall, 174 patients were reclassified into a higher risk category (17.3%) and 421 into a lower risk category (41.9%).
Conclusion:
Anaemia provides independent additional prognostic information to the GRACE score. Combining anaemia with the GRACE score refines its predictive value, which often overestimates the risk.
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