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Published on: June 10, 2025
Gender differences in the association between discharge hemoglobin and 12-month mortality after acute myocardial
Lauren E Thompson1,2, Frederick A Masoudi1,2, Kensey L Gosch3
1Division of Cardiology, Aurora, Colorado.
Insights
Anemia at discharge after acute myocardial infarction (AMI) is linked to worse outcomes for both women and men. This association is linear, meaning any drop in hemoglobin levels indicates a higher risk of mortality within 12 months.
Area of Science:
- Cardiology
- Hematology
- Clinical Outcomes Research
Background:
- Anemia at discharge following acute myocardial infarction (AMI) is a known predictor of poor prognosis.
- However, the influence of gender on this relationship and the existence of a specific hemoglobin (Hb) threshold remain unclear.
Purpose of the Study:
- To investigate the association between discharge hemoglobin (Hb) levels and 12-month mortality in patients with AMI.
- To determine if this relationship differs between women and men or exhibits a nonlinear pattern.
Main Methods:
- Utilized data from the TRIUMPH registry (2005-2008) for 4243 AMI patients.
- Employed multivariable models to assess the link between discharge Hb and 12-month mortality, testing for gender interactions.
- Used restricted cubic splines to evaluate the linearity of the Hb-mortality relationship.
Main Results:
- Lower discharge Hb was independently associated with increased 12-month mortality (P < 0.05).
- The association between Hb decline and mortality was similar in women and men (HR: ~1.24-1.25 per 1-g/dL decrease; P for gender interaction = 0.99).
- The relationship between discharge Hb and mortality was linear, with no significant nonlinear spline term (P = 0.12).
Conclusions:
- Discharge anemia in AMI patients is similarly linked to increased 12-month mortality in both genders.
- The relationship is linear, indicating that any reduction in hemoglobin levels at discharge is associated with adverse outcomes.
Background:
Anemia at discharge in patients with acute myocardial infarction is associated with poor prognosis; whether this differs in women and men or if there is a threshold value at which these relationships change is unknown.
Hypothesis:
Women have a lower discharge hemoglobin (Hb) at which outcomes worsen.
Methods:
We identified patients with acute myocardial infarction in the TRIUMPH registry between 2005 and 2008. In multivariable models, we evaluated the relationship between discharge Hb and 12-month mortality and tested whether this relationship varied by gender. We assessed whether the relationship with discharge Hb values was nonlinear using a restricted cubic spline term.
Results:
Of 4243 patients with AMI, 32.9% were female. Mean admission Hb was 12.9 ± 1.9 g/dL in women and 14.5 ± 2.0 g/dL in men, with mean discharge Hb 11.4 ± 1.8 g/dL and 12.9 ± 1.9 g/dL, respectively. Lower discharge Hb was independently associated with increased mortality (P < 0.05). In multivariable models, discharge Hb decline was similarly associated with increased 12-month mortality in women and men (per 1-g/dL decrease Hb; women HR: 1.24, 95% CI: 1.09-1.42, P < 0.01; and men HR: 1.25, 95% CI: 1.13-1.37, P < 0.01; P for gender interaction = 0.99). The relationship between discharge Hb and 12-month mortality was linear (P for nonlinear spline term = 0.12).
Conclusions:
Lower discharge Hb levels were similarly associated with increased 12-month mortality in women and men. These relationships are linear without a clear threshold, suggesting any decline in discharge Hb is associated with poor outcomes.
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