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Hemoglobin and Change in Hemoglobin Status Predict Mortality, Cardiovascular Events, and Bleeding in Stable Coronary
Paul R Kalra1, Nicola Greenlaw2, Roberto Ferrari3
1Portsmouth Hospital NHS Trust, Portsmouth and NHLI Imperial College, London, United Kingdom.
Insights
Low hemoglobin levels and anemia are significant predictors of mortality and major bleeding in patients with stable coronary artery disease. Persisting or new anemia indicates a higher risk for cardiovascular and noncardiovascular death.
Area of Science:
- Cardiology
- Hematology
- Epidemiology
Background:
- Anemia is a known predictor of adverse outcomes in acute myocardial infarction.
- The study investigates the link between hemoglobin levels and outcomes in stable coronary artery disease patients.
Purpose of the Study:
- To examine the association of baseline hemoglobin and its changes over time with mortality, cardiovascular events, and major bleeding in stable coronary artery disease patients.
Main Methods:
- A prospective cohort study of 32,901 patients with stable coronary artery disease was conducted.
- Patients were categorized by baseline hemoglobin levels and anemia status at baseline and follow-up.
- All-cause mortality, cardiovascular events, and major bleeding were assessed over a 4-year follow-up period.
Main Results:
- Low baseline hemoglobin independently predicted all-cause, cardiovascular, and noncardiovascular mortality, as well as major bleeds.
- Anemia at follow-up was associated with increased all-cause, noncardiovascular, and cardiovascular mortality.
- Patients whose anemia normalized had no increased mortality risk but a higher risk of major bleeding.
Conclusions:
- Low hemoglobin is an independent predictor of mortality, cardiovascular events, and major bleeding in stable coronary artery disease.
- Persistent or new-onset anemia strongly predicts both 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.
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