Low Hb levels at admission associated with higher CV and all cause mortality

New investigation revealed that lower levels of hemoglobin at admission are associated with higher cardiovascular, all-cause mortality, and major ischemic events among elderly patients with the acute coronary syndrome who are managed invasively. The study was published in the "International Journal of Cardiology", 2022. 

Hemoglobin (Hb) levels have popped up as a useful tool for risk stratification and the prediction of outcomes after myocardial infarction in patients with cardiovascular issues admitted to a hospital. To understand this, researchers conducted a trial to evaluate the prognostic impact of hemoglobin on elderly patients, where the larger prevalence of anemia and the higher rate of comorbidities could directly impact cardiovascular risk. 

Subjects from the ELDERLY-2 trial were included in this analysis. They were stratified according to the values of hemoglobin at admission. Cardiovascular mortality within one year was the primary endpoint of measurement. All-cause mortality, MI, Bleeding Academic Research Consortium (BARC) type 2–3 or 5 bleeding, any stroke, re-hospitalization for a cardiovascular event or stent thrombosis (probable or definite) within 12 months after index admission were the secondary endpoints of measurement. 

Results: 

• 1364 patients were included in the analysis.
• They were divided into quartiles of Hb values of <12.2; 12.2–13.39; 13.44–14.49; ≥ 4.5 g/dl.
• At mean follow-up of 330.4 ± 99.9 days cardiovascular mortality was increased in patients with lower Hb.
• Results were no more significant after correction for baseline differences.
• Similar results were observed for overall mortality.
• At subgroup analysis, (according to Hb median values) a significant interaction was observed only with the type of antiplatelet therapy, but not with major high-risk subsets of patients. 

Thus, the researchers concluded that among elderly patients with acute coronary syndrome managed invasively, lower hemoglobin levels at admission are associated with higher cardiovascular and all-cause mortality and major ischemic events. 

For the full article, click here: https://doi.org/10.1016/j.ijcard.2022.07.033

De Luca G, Verdoia M, Morici N, et al. Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial. International Journal of Cardiology. Published online July 2022.