Skip to main content
Top
Published in: Heart and Vessels 2/2012

01-03-2012 | Original Article

Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

Authors: Sylvestre Maréchaux, Stéphanie Barrailler, Claire Pinçon, Vincent Decourcelle, Thomas Guidez, Sophie Braun, Nadia Bouabdallaoui, Jean-Jacques Bauchart, Jean Luc Auffray, Francis Juthier, Carlo Banfi, Sophie Susen, Brigitte Jude, Philippe Asseman, Eric Van Belle, Pierre Vladimir Ennezat

Published in: Heart and Vessels | Issue 2/2012

Login to get access

Abstract

In this work, we analyzed the prognostic significance of changes in hemoglobin during intensive care unit (ICU) stay in patients with acute coronary syndromes (ACS). We prospectively enrolled 591 patients (62 ± 14 years old, 73% male, 48% ST elevated myocardial infarction) free of blood cell transfusion or bleeding events. Changes in hemoglobin between admission and ICU discharge were obtained. The primary endpoint was death or hospitalization for MI within 6 months. Hemoglobin decreased from 13.65 ± 1.77 to 13.17 ± 1.74 g/dl, p < 0.0001 in the whole population. The end point was reached in 43 patients at a mean follow-up of 180 (range 2–180 days). A decrease in hemoglobin ≥0.9 g/dl (32% of the population) was associated with adverse clinical outcomes (HR 2.37, 95% CI (1.30–4.35), p = 0.005, respectively). In multivariate analysis, age >77 year-old (p = 0.0016), Killip class ≥2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline ≥0.9 g/dl (p < 0.0001) were independently associated with outcome. Hemoglobin decline and anemia both provided additional prognostic information on top of the GRACE score, as demonstrated by a systematic improvement in model global fit, discrimination, and calibration. Hemoglobin decline is frequent during ICU stay in non-bleeding ACS patients. A decline in hemoglobin ≥0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.
Literature
1.
go back to reference Catakoglu AB, Aytekin S, Sener M, Kurtoglu H, Celebi H, Demiroglu IC, Aytekin V (2007) Impact of anemia on nonfatal coronary events after percutaneous coronary interventions. Heart Vessels 22:383–388PubMedCrossRef Catakoglu AB, Aytekin S, Sener M, Kurtoglu H, Celebi H, Demiroglu IC, Aytekin V (2007) Impact of anemia on nonfatal coronary events after percutaneous coronary interventions. Heart Vessels 22:383–388PubMedCrossRef
2.
go back to reference Lee RJ, Shih KN, Lee SH, Shyu KG, Chiu CZ, Lin SC, Hung HF, Liou JY, Cheng JJ, Kuan P (2007) Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease. Heart Vessels 22:99–103PubMedCrossRef Lee RJ, Shih KN, Lee SH, Shyu KG, Chiu CZ, Lin SC, Hung HF, Liou JY, Cheng JJ, Kuan P (2007) Predictors of long-term outcomes in patients after elective stent implantation for unprotected left main coronary artery disease. Heart Vessels 22:99–103PubMedCrossRef
3.
go back to reference Turner SJ, Ketch TR, Gandhi SK, Sane DC (2008) Routine hematologic clinical tests as prognostic markers in patients with acute coronary syndromes. Am Heart J 155:806–816PubMedCrossRef Turner SJ, Ketch TR, Gandhi SK, Sane DC (2008) Routine hematologic clinical tests as prognostic markers in patients with acute coronary syndromes. Am Heart J 155:806–816PubMedCrossRef
4.
go back to reference Meneveau N, Schiele F, Seronde MF, Descotes-Genon V, Oettinger J, Chopard R, Ecarnot F, Bassand JP (2009) Anemia for risk assessment of patients with acute coronary syndromes. Am J Cardiol 103:442–447PubMedCrossRef Meneveau N, Schiele F, Seronde MF, Descotes-Genon V, Oettinger J, Chopard R, Ecarnot F, Bassand JP (2009) Anemia for risk assessment of patients with acute coronary syndromes. Am J Cardiol 103:442–447PubMedCrossRef
5.
go back to reference Lipsic E, van der Horst IC, Voors AA, van der Meer P, Nijsten MW, van Gilst WH, van Veldhuisen DJ, Zijlstra F (2005) Hemoglobin levels and 30-day mortality in patients after myocardial infarction. Int J Cardiol 100:289–292PubMedCrossRef Lipsic E, van der Horst IC, Voors AA, van der Meer P, Nijsten MW, van Gilst WH, van Veldhuisen DJ, Zijlstra F (2005) Hemoglobin levels and 30-day mortality in patients after myocardial infarction. Int J Cardiol 100:289–292PubMedCrossRef
6.
go back to reference Nikolsky E, Aymong ED, Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Cohen DA, Negoita M, Lansky AJ, Stone GW (2004) Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol 44:547–553PubMedCrossRef Nikolsky E, Aymong ED, Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Cohen DA, Negoita M, Lansky AJ, Stone GW (2004) Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol 44:547–553PubMedCrossRef
7.
go back to reference Budaj A, Eikelboom JW, Mehta SR, Afzal R, Chrolavicius S, Bassand JP, Fox KA, Wallentin L, Peters RJ, Granger CB, Joyner CD, Yusuf S (2009) Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 30:655–661PubMedCrossRef Budaj A, Eikelboom JW, Mehta SR, Afzal R, Chrolavicius S, Bassand JP, Fox KA, Wallentin L, Peters RJ, Granger CB, Joyner CD, Yusuf S (2009) Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 30:655–661PubMedCrossRef
8.
go back to reference Alexander KP, Chen AY, Wang TY, Rao SV, Newby LK, LaPointe NM, Ohman EM, Roe MT, Boden WE, Harrington RA, Peterson ED (2008) Transfusion practice and outcomes in non-ST-segment elevation acute coronary syndromes. Am Heart J 155:1047–1053PubMedCrossRef Alexander KP, Chen AY, Wang TY, Rao SV, Newby LK, LaPointe NM, Ohman EM, Roe MT, Boden WE, Harrington RA, Peterson ED (2008) Transfusion practice and outcomes in non-ST-segment elevation acute coronary syndromes. Am Heart J 155:1047–1053PubMedCrossRef
9.
go back to reference Aronson D, Suleiman M, Agmon Y, Suleiman A, Blich M, Kapeliovich M, Beyar R, Markiewicz W, Hammerman H (2007) Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction. Eur Heart J 28:1289–1296PubMedCrossRef Aronson D, Suleiman M, Agmon Y, Suleiman A, Blich M, Kapeliovich M, Beyar R, Markiewicz W, Hammerman H (2007) Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction. Eur Heart J 28:1289–1296PubMedCrossRef
10.
go back to reference Previsdomini M, Stocker R, Corti R, Cerutti B, Perren A (2007) Time course of hemoglobin concentrations in the intensive care unit in nonbleeding patients with acute coronary syndrome. Am J Cardiol 100:579–582PubMedCrossRef Previsdomini M, Stocker R, Corti R, Cerutti B, Perren A (2007) Time course of hemoglobin concentrations in the intensive care unit in nonbleeding patients with acute coronary syndrome. Am J Cardiol 100:579–582PubMedCrossRef
11.
go back to reference Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. J Am Coll Cardiol 50:2173–2195PubMedCrossRef Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. J Am Coll Cardiol 50:2173–2195PubMedCrossRef
12.
go back to reference Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538PubMedCrossRef Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538PubMedCrossRef
13.
go back to reference Langford K, Luchtman-Jones L, Miller R, Walck D (2003) Performance evaluation of the Sysmex XT-2000i automated hematology analyzer. Lab Hematol 9:29–37PubMed Langford K, Luchtman-Jones L, Miller R, Walck D (2003) Performance evaluation of the Sysmex XT-2000i automated hematology analyzer. Lab Hematol 9:29–37PubMed
14.
go back to reference Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMed Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMed
15.
go back to reference Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A, Goodman SG, Flather MD, Anderson FA Jr, Granger CB (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 333:1091PubMedCrossRef Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A, Goodman SG, Flather MD, Anderson FA Jr, Granger CB (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 333:1091PubMedCrossRef
16.
go back to reference Schoenfeld D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69:239–241CrossRef Schoenfeld D (1982) Partial residuals for the proportional hazards regression model. Biometrika 69:239–241CrossRef
17.
go back to reference May S, Hosmer DW (2004) An added variable goodness-of-fit test for the Cox proportional hazards model. Biom J 46:343–350CrossRef May S, Hosmer DW (2004) An added variable goodness-of-fit test for the Cox proportional hazards model. Biom J 46:343–350CrossRef
18.
go back to reference Harrell FE, Lee KL, Mark DB (1996) Multivariable prognostic models issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387PubMedCrossRef Harrell FE, Lee KL, Mark DB (1996) Multivariable prognostic models issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387PubMedCrossRef
19.
go back to reference Kent JT, O’Quigley J (1988) Measures of dependence for censored survival data. Biometrika 75:525–534CrossRef Kent JT, O’Quigley J (1988) Measures of dependence for censored survival data. Biometrika 75:525–534CrossRef
20.
go back to reference Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, Gibson CM, Braunwald E (2005) Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 111:2042–2049PubMedCrossRef Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, Gibson CM, Braunwald E (2005) Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 111:2042–2049PubMedCrossRef
21.
go back to reference Kimura H, Hiramitsu S, Miyagishima K, Mori K, Yoda R, Kato S, Kato Y, Morimoto S, Hishida H, Ozaki Y (2010) Cardio-renal interaction: impact of renal function and anemia on the outcome of chronic heart failure. Heart Vessels 25:306–312PubMedCrossRef Kimura H, Hiramitsu S, Miyagishima K, Mori K, Yoda R, Kato S, Kato Y, Morimoto S, Hishida H, Ozaki Y (2010) Cardio-renal interaction: impact of renal function and anemia on the outcome of chronic heart failure. Heart Vessels 25:306–312PubMedCrossRef
22.
go back to reference Marechaux S, Six-Carpentier MM, Bouabdallaoui N, Montaigne D, Bauchart JJ, Mouquet F, Auffray JL, Le Tourneau T, Asseman P, Lejemtel TH, Ennezat PV (2010) Prognostic importance of comorbidities in heart failure with preserved left ventricular ejection fraction. Heart Vessels. doi:10.1007/s00380-010-0057-5 Marechaux S, Six-Carpentier MM, Bouabdallaoui N, Montaigne D, Bauchart JJ, Mouquet F, Auffray JL, Le Tourneau T, Asseman P, Lejemtel TH, Ennezat PV (2010) Prognostic importance of comorbidities in heart failure with preserved left ventricular ejection fraction. Heart Vessels. doi:10.​1007/​s00380-010-0057-5
23.
go back to reference Bassand JP, Afzal R, Eikelboom J, Wallentin L, Peters R, Budaj A, Fox KA, Joyner CD, Chrolavicius S, Granger CB, Mehta S, Yusuf S (2010) Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes. Eur Heart J 31:50–58PubMedCrossRef Bassand JP, Afzal R, Eikelboom J, Wallentin L, Peters R, Budaj A, Fox KA, Joyner CD, Chrolavicius S, Granger CB, Mehta S, Yusuf S (2010) Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes. Eur Heart J 31:50–58PubMedCrossRef
24.
go back to reference Dauerman HL, Lessard D, Yarzebski J, Gore JM, Goldberg RJ (2005) Bleeding complications in patients with anemia and acute myocardial infarction. Am J Cardiol 96:1379–1383PubMedCrossRef Dauerman HL, Lessard D, Yarzebski J, Gore JM, Goldberg RJ (2005) Bleeding complications in patients with anemia and acute myocardial infarction. Am J Cardiol 96:1379–1383PubMedCrossRef
25.
go back to reference Sjauw KD, van der Horst IC, Nijsten MW, Nieuwland W, Zijlstra F (2006) Value of routine admission laboratory tests to predict thirty-day mortality in patients with acute myocardial infarction. Am J Cardiol 97:1435–1440PubMedCrossRef Sjauw KD, van der Horst IC, Nijsten MW, Nieuwland W, Zijlstra F (2006) Value of routine admission laboratory tests to predict thirty-day mortality in patients with acute myocardial infarction. Am J Cardiol 97:1435–1440PubMedCrossRef
26.
go back to reference Anand I, McMurray JJ, Whitmore J, Warren M, Pham A, McCamish MA, Burton PB (2004) Anemia and its relationship to clinical outcome in heart failure. Circulation 110:149–154PubMedCrossRef Anand I, McMurray JJ, Whitmore J, Warren M, Pham A, McCamish MA, Burton PB (2004) Anemia and its relationship to clinical outcome in heart failure. Circulation 110:149–154PubMedCrossRef
27.
go back to reference O’Riordan E, Foley RN (2000) Effects of anaemia on cardiovascular status. Nephrol Dial Transplant 15(Suppl 3):19–22PubMed O’Riordan E, Foley RN (2000) Effects of anaemia on cardiovascular status. Nephrol Dial Transplant 15(Suppl 3):19–22PubMed
28.
go back to reference Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, Burgess E, Jindal K, Barrett B, Singer J, Djurdjev O (1999) Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 34:125–134PubMedCrossRef Levin A, Thompson CR, Ethier J, Carlisle EJ, Tobe S, Mendelssohn D, Burgess E, Jindal K, Barrett B, Singer J, Djurdjev O (1999) Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 34:125–134PubMedCrossRef
29.
go back to reference Liron M (2007) Nosocomial anaemia. Eur Heart J 28:2551 (author reply 2551–2552) Liron M (2007) Nosocomial anaemia. Eur Heart J 28:2551 (author reply 2551–2552)
Metadata
Title
Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome
Authors
Sylvestre Maréchaux
Stéphanie Barrailler
Claire Pinçon
Vincent Decourcelle
Thomas Guidez
Sophie Braun
Nadia Bouabdallaoui
Jean-Jacques Bauchart
Jean Luc Auffray
Francis Juthier
Carlo Banfi
Sophie Susen
Brigitte Jude
Philippe Asseman
Eric Van Belle
Pierre Vladimir Ennezat
Publication date
01-03-2012
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 2/2012
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-011-0127-3

Other articles of this Issue 2/2012

Heart and Vessels 2/2012 Go to the issue