Relationship between hemoglobin level and in-hospital prognosis in elderly patients with acute coronary syndrome_West China Medical Journal

Authors：

 KANG Yi ¹ , ZHAO Xin ² , LU Chunpeng ¹ , WANG Jing ¹ , XIONG Weiguo ¹ , SUN Yuwen ¹

1. Heart Center, the First Hospital of Tsinghua University, Beijing 100016, P. R. China;
2. Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, P. R. China;

Corresponding author：

KANG Yi, Email: 734429745@qq.com

Keywords：

Hemoglobin; Elderly patient; Acute coronary syndrome; In-hospital prognosis

DOI：

10.7507/1002-0179.202003404

Video：

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Objective To investigate the influence of hemoglobin level on in-hospital outcome of elderly patients with acute coronary syndrome (ACS).Methods This study retrospectively collected 262 elderly patients with ACS in the First Hospital of Tsinghua University from January 2015 to August 2019. Patients were divided into 4 groups according to the hemoglobin level. Patients with hemoglobin level≤121.75 g/L were classified into group A (n=65), patients with hemoglobin level between 121.76 and 132.50 g/L were classified into group B (n=66), patients with hemoglobin level between 132.51 and 144.00 g/L were classified into group C (n=69), and patients with hemoglobin level≥144.01 g/L were classified into group D (n=62). The primary endpoints of this study were in-hospital major adverse cardiovascular events, including all-cause death, reinfarction, acute or subacute stent thrombosis and cardiac arrest. Logistic regression analysis was used to explore the effect of hemoglobin on the in-hospital prognosis of elderly patients with ACS.Results Logistic regression analysis showed that the odds ratio of hemoglobin level in the major adverse cardiovascular events assessment was 0.971, the 95% confidence interval was (0.946, 0.996) and the P value was 0.024, while the odds ratio of hemoglobin level in the all-cause death assessment was 0.957, the 95% confidence interval was (0.929, 0.987) and the P value was 0.005.Conclusion Low hemoglobin level is a risk factor for in-hospital adverse events in the elderly patients with ACS.

Citation： KANG Yi, ZHAO Xin, LU Chunpeng, WANG Jing, XIONG Weiguo, SUN Yuwen. Relationship between hemoglobin level and in-hospital prognosis in elderly patients with acute coronary syndrome. West China Medical Journal, 2021, 36(1): 61-65. doi: 10.7507/1002-0179.202003404 Copy

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2.	Nikolsky E, Aymong ED, Halkin A, et al. 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, 2004, 44(3): 547-553.
3.	Lawler PR, Filion KB, Dourian T, et al. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J, 2013, 165(2): 143-153.
4.	Younge JO, Nauta ST, Akkerhuis KM, et al. Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes. Am J Cardiol, 2012, 109(4): 506-510.
5.	Ennezat PV, Maréchaux S, Pinçon C, et al. Anaemia to predict outcome in patients with acute coronary syndromes. Arch Cardiovasc Dis, 2013, 106(6/7): 357-365.
6.	Maréchaux S, Barrailler S, Pinçon C, et al. Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome. Heart Vessels, 2012, 27(2): 119-127.
7.	中国急性冠状动脉综合征多中心临床研究协作组. 中国多省市急性冠状动脉综合征住院患者治疗现状与指南差距分析. 中华心血管病杂志, 2005, 33(9): 789-792.
8.	刘群, 赵冬, 刘军, 等. 中国ST段抬高急性冠状动脉综合征诊疗现况调查. 中华心血管病杂志, 2009, 37(3): 213-217.
9.	高晓津, 杨进刚, 杨跃进, 等. 中国急性心肌梗死患者心血管危险因素分析. 中国循环杂志, 2015(3): 206-210.
10.	Li J, Li X, Wang Q, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet, 2015, 385(9966): 441-451.
11.	Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med, 2008, 359(5): 482-491.
12.	Conklin DJ, Schick S, Blaha MJ, et al. Cardiovascular injury induced by tobacco products: assessment of risk factors and biomarkers of harm. A tobacco centers of regulatory science compilation. Am J Physiol Heart Circ Physiol, 2019, 316(4): H801-H827.
13.	National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking—50 years of progress: a report of the surgeon general. Atlanta (GA): Centers for Disease Control and Prevention (US), 2014: 1-2.
14.	Houghton DE, Koh I, Ellis A, et al. Hemoglobin levels and coronary heart disease risk by age, race, and sex in the reasons for geographic and racial differences in stroke study (REGARDS). Am J Hematol, 2020, 95(3): 258-266.
15.	Kimberly WT, Lima FO, O’Connor, et al. Sex differences and hemoglobin levels in relation to stroke outcomes. Neurology, 2013, 80(8): 719-724.
16.	Ji C, Su Y, Zhang C, et al. Reference intervals for hemoglobin and age- and gender-related trends in the population of southwest China. Clin Lab, 2015, 61(12): 1831-1836.
17.	Bindra K, Berry C, Rogers J, et al. Abnormal haemoglobin levels in acute coronary syndromes. QJM, 2006, 99(12): 851-862.
18.	Huynh R, Hyun K, D’Souza M, et al. Outcomes of anemic patients presenting with acute coronary syndrome: an analysis of the cooperative national registry of acute coronary care, guideline adherence and clinical events. Clin Cardiol, 2019, 42(9): 791-796.
19.	Mamas MA, Kwok CS, Kontopantelis E, et al. Relationship between anemia and mortality outcomes in a national acute coronary syndrome cohort: insights from the UK myocardial ischemia national audit project registry. J Am Heart Assoc, 2016, 5(11): e003348.
20.	Cheng CC, Huang WC, Chiou KR, et al. Body mass index and outcome of acute myocardial infarction - is there an obesity paradox?. Acta Cardiol Sin, 2013, 29(5): 413-420.
21.	陆秋芬, 许之民. 急性冠脉综合征患者血红蛋白水平与临床预后关系的探讨. 实用诊断与治疗杂志, 2006, 20(10): 711-712.
22.	向凝, 杨柳, 谢登海. 血红蛋白水平对老年急性冠脉综合征患者近期预后的影响. 贵州医药, 2011, 35(5): 412-414.
23.	Al Falluji N, Lawrence-Nelson J, Kostis JB, et al. Effect of anemia on 1-year mortality in patients with acute myocardial infarction. Am Heart J, 2002, 144(4): 636-641.

1. Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation, 2005, 111(16): 2042-2049.
2. Nikolsky E, Aymong ED, Halkin A, et al. 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, 2004, 44(3): 547-553.
3. Lawler PR, Filion KB, Dourian T, et al. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J, 2013, 165(2): 143-153.
4. Younge JO, Nauta ST, Akkerhuis KM, et al. Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes. Am J Cardiol, 2012, 109(4): 506-510.
5. Ennezat PV, Maréchaux S, Pinçon C, et al. Anaemia to predict outcome in patients with acute coronary syndromes. Arch Cardiovasc Dis, 2013, 106(6/7): 357-365.
6. Maréchaux S, Barrailler S, Pinçon C, et al. Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome. Heart Vessels, 2012, 27(2): 119-127.
7. 中国急性冠状动脉综合征多中心临床研究协作组. 中国多省市急性冠状动脉综合征住院患者治疗现状与指南差距分析. 中华心血管病杂志, 2005, 33(9): 789-792.
8. 刘群, 赵冬, 刘军, 等. 中国ST段抬高急性冠状动脉综合征诊疗现况调查. 中华心血管病杂志, 2009, 37(3): 213-217.
9. 高晓津, 杨进刚, 杨跃进, 等. 中国急性心肌梗死患者心血管危险因素分析. 中国循环杂志, 2015(3): 206-210.
10. Li J, Li X, Wang Q, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet, 2015, 385(9966): 441-451.
11. Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med, 2008, 359(5): 482-491.
12. Conklin DJ, Schick S, Blaha MJ, et al. Cardiovascular injury induced by tobacco products: assessment of risk factors and biomarkers of harm. A tobacco centers of regulatory science compilation. Am J Physiol Heart Circ Physiol, 2019, 316(4): H801-H827.
13. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking—50 years of progress: a report of the surgeon general. Atlanta (GA): Centers for Disease Control and Prevention (US), 2014: 1-2.
14. Houghton DE, Koh I, Ellis A, et al. Hemoglobin levels and coronary heart disease risk by age, race, and sex in the reasons for geographic and racial differences in stroke study (REGARDS). Am J Hematol, 2020, 95(3): 258-266.
15. Kimberly WT, Lima FO, O’Connor, et al. Sex differences and hemoglobin levels in relation to stroke outcomes. Neurology, 2013, 80(8): 719-724.
16. Ji C, Su Y, Zhang C, et al. Reference intervals for hemoglobin and age- and gender-related trends in the population of southwest China. Clin Lab, 2015, 61(12): 1831-1836.
17. Bindra K, Berry C, Rogers J, et al. Abnormal haemoglobin levels in acute coronary syndromes. QJM, 2006, 99(12): 851-862.
18. Huynh R, Hyun K, D’Souza M, et al. Outcomes of anemic patients presenting with acute coronary syndrome: an analysis of the cooperative national registry of acute coronary care, guideline adherence and clinical events. Clin Cardiol, 2019, 42(9): 791-796.
19. Mamas MA, Kwok CS, Kontopantelis E, et al. Relationship between anemia and mortality outcomes in a national acute coronary syndrome cohort: insights from the UK myocardial ischemia national audit project registry. J Am Heart Assoc, 2016, 5(11): e003348.
20. Cheng CC, Huang WC, Chiou KR, et al. Body mass index and outcome of acute myocardial infarction - is there an obesity paradox?. Acta Cardiol Sin, 2013, 29(5): 413-420.
21. 陆秋芬, 许之民. 急性冠脉综合征患者血红蛋白水平与临床预后关系的探讨. 实用诊断与治疗杂志, 2006, 20(10): 711-712.
22. 向凝, 杨柳, 谢登海. 血红蛋白水平对老年急性冠脉综合征患者近期预后的影响. 贵州医药, 2011, 35(5): 412-414.
23. Al Falluji N, Lawrence-Nelson J, Kostis JB, et al. Effect of anemia on 1-year mortality in patients with acute myocardial infarction. Am Heart J, 2002, 144(4): 636-641.

West China Medical Journal

Relationship between hemoglobin level and in-hospital prognosis in elderly patients with acute coronary syndrome

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