Kalra, P. R. et al. (2017) Hemoglobin and change in hemoglobin status predict mortality, cardiovascular events and bleeding in stable coronary artery disease. American Journal of Medicine, 130(6), pp. 720-730. (doi: 10.1016/j.amjmed.2017.01.002) (PMID:28109968)
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Abstract
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: CLARIFY 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 [A] or normal [N]) at baseline/follow-up: N/N; A/N; N/A; A/A. 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 A/A; 1.87; 1.54-2.28 for N/A; both P <.001), noncardiovascular mortality (P <.001), and cardiovascular mortality (P = .001). Patients whose baseline anemia normalized (A/N) were not at increased risk of death (HR, 1.02; 95% CI, 0.77-1.35), although 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. Conclusion: In this large stable coronary artery disease population, 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.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Greenlaw, Miss Nicola and Ford, Professor Ian |
Authors: | Kalra, P. R., Greenlaw, N., Ferrari, R., Ford, I., Tardif, J.-C., Tendera, M., Reid, C. M., Danchin, N., Stepinska, J., Steg, P. G., and Fox, K. M. |
College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | American Journal of Medicine |
Publisher: | Elsevier |
ISSN: | 0002-9343 |
ISSN (Online): | 1555-7162 |
Published Online: | 19 January 2017 |
Copyright Holders: | Copyright © 2017 Elsevier Inc. |
First Published: | First published in American Journal of Medicine 130(6):720-730 |
Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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