Abnormal haemoglobin levels in acute coronary syndromes

Bindra, K., Berry, C. , Rogers, J., Stewart, N., Watts, M., Christie, J., Cobbe, S.M. and Eteiba, H. (2006) Abnormal haemoglobin levels in acute coronary syndromes. QJM: An International Journal of Medicine, 99(12), pp. 851-862. (doi: 10.1093/qjmed/hcl117)

Abstract

Background: Anaemia is an adverse prognostic marker in acute coronary syndromes (ACS), but the epidemiology of abnormal haemoglobin levels in such patients is uncertain. Aims: To investigate the prevalence, nature and predictors of abnormal haemoglobin levels in ACS patients at admission. Design: Observational study. Methods: All emergency admissions from January to April 2005 were assessed within 24–48h of hospital admission. ACS patients (unstable angina, non-ST-elevation or ST-elevation myocardial infarction) were enrolled (n = 320, 190 men). Clinical information was recorded. Results: Overall, 71% had unstable angina; 18% non-ST-elevation myocardial infarction (MI), and 11% ST-elevation MI. Mean ± SD haemoglobin was 14.3 ± 1.7g/dl in men and 13.2 ± 1.5g/dl in women. Abnormal haemoglobin was more common in men (65, 34%) than in women (34, 22%) (p = 0.013). Anaemia (haemoglobin <13g/dl in men, or <12.0g/dl in women) was recorded in 35 (18%) men and 24 (18%) women. All had admission haemoglobin >8g/dl, and anaemia was usually normocytic. Multivariate predictors of anaemia (OR, 95%CI) were age (1.07, 1.04–1.1) and serum albumin (0.90, 0.81–1.00). Elevated haemoglobin (>16?g/dl) was recorded in 30 (16%) men and 4 (3%) women (p < 0.01), and was more common in ST-elevation MI patients (26%) than in unstable angina or non-ST elevation MI patients (9%) (p = 0.005). In patients who underwent invasive management with a post-procedure haemoglobin the following day (n = 85), 15 (18%) new cases of anaemia were detected. Admission duration correlated with haemoglobin (p < 0.01), creatinine (p < 0.01), troponin I (p < 0.01) and C-reactive protein (p < 0.01). Anaemia was more common in those who died in hospital (3, 60%) than in those who survived (56, 18%) (adjusted p = 0.0135). Discussion: Abnormal haemoglobin levels were common in our ACS admissions. Anaemia was generally mild. Increasing age and interventional management were associated with anaemia, which in turn was associated with adverse in-hospital outcomes. Interventions to prevent and detect anaemia in this setting merit prospective testing.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Eteiba, Professor Hany and Berry, Professor Colin and Cobbe, Professor Stuart
• Authors: Bindra, K., Berry, C., Rogers, J., Stewart, N., Watts, M., Christie, J., Cobbe, S.M., and Eteiba, H.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: QJM: An International Journal of Medicine
• Publisher: Oxford University Press
• ISSN: 1460-2725