Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Sylvestre Mare´chaux Ste´phanie Barrailler Claire Pinc¸on Vincent Decourcelle Thomas Guidez Sophie Braun Nadia Bouabdallaoui Jean-Jacqu
- چاپ و سال / کشور: 2011
Description
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 C0.9 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 C2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline C0.9 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 nonbleeding ACS patients. A decline in hemoglobin C0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.
Heart Vessels DOI 10.1007/s00380-011-0127-3 Received: 2 September 2010 / Accepted: 18 February 2011
