Clinical Research in Cardiology

, Volume 101, Issue 1, pp 37–44

In-hospital prognostic value of hemoglobin levels on admission in patients with acute ST segment elevation myocardial infarction undergoing primary angioplasty

  • Cihan Dündar
  • Vecih Oduncu
  • Ayhan Erkol
  • Ali Cevat Tanalp
  • Dicle Sırma
  • Ali Karagöz
  • Can Yücel Karabay
  • Alev Kılıçgedik
  • Selçuk Pala
  • Kürşat Tigen
  • Akın Izgi
  • Cevat Kırma
Original Paper



Anemia is a common comorbidity in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate the in-hospital prognostic value of admission hemoglobin (Hb) levels in patients with acute STEMI undergoing primary percutaneous coronary intervention (p-PCI).


This is a retrospective study of 1,625 patients with STEMI stratified by quartiles of admission Hb concentration (Q1 ≤12.5 g/dl, Q2 12.6–13.8 g/dl, Q3 13.9–15.0 g/dl, Q4 ≥15.1 g/dl). Main outcome measures were in-hospital rates of all cause mortality, re-infarction, target vessel revascularization, stroke, heart failure (HF) and bleeding complications.


The incidences of in-hospital mortality according to quartiles from Q1 to Q4 were 8.6, 3.9, 2.4 and 2.6%, respectively (p < 0.001). The incidences of major hemorrhage and HF were significantly higher in Q1, compared to the other quartiles (7.4, 1.9, 3.1, 2.8%, p < 0.001; 16.3, 8.5, 7.7, 9.8%, p < 0.001, respectively). Multiple logistic-regression analysis showed that low admission Hb level (Q1) is an independent and a potent predictor for in-hospital mortality [unadjusted odds ratio (OR): 3.84, 95% confidence interval (CI): 1.78–7.82; p < 0.001].


Lower concentrations of Hb on admission are associated with higher rates of in-hospital mortality, heart failure and major bleeding after p-PCI.


Hemoglobin Myocardial infarction Percutaneous coronary intervention Prognosis 


  1. 1.
    Nikolsky E, Aymong ED, Halkin A et al (2004) 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 44:547–553PubMedCrossRefGoogle Scholar
  2. 2.
    Sabatine MS, Morrow DA, Giugliano RP et al (2005) Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 111:2042–2049PubMedCrossRefGoogle Scholar
  3. 3.
    Spencer FA, Moscucci M, Granger CB et al (2007) Does comorbidity account for the excess mortality in patients with major bleeding in acute myocardial infarction? Circulation 116:2793–2801PubMedCrossRefGoogle Scholar
  4. 4.
    Bassand JP, Afzal R, Eikelboom J et al (2010) Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes. Eur Heart J 31:50–58PubMedCrossRefGoogle Scholar
  5. 5.
    Dauerman HL, Lessard D, Yarzebski J et al (2005) Bleeding complications in patients with anemia and acute myocardial infarction. Am J Cardiol 96:1379–1383PubMedCrossRefGoogle Scholar
  6. 6.
    McKechnie RS, Smith D, Montoye C et al (2004) Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation 110:271–277PubMedCrossRefGoogle Scholar
  7. 7.
    Levy PS, Kim SJ, Eckel PK et al (1993) Limit to cardiac compensation during acute isovolemic hemodilution: influence of coronary stenosis. Am J Physiol 265:H340–H349PubMedGoogle Scholar
  8. 8.
    Most AS, Ruocco NA Jr, Gewirtz H (1986) Effect of a reduction in blood viscosity on maximal myocardial oxygen delivery distal to a moderate coronary stenosis. Circulation 74:1085–1092PubMedCrossRefGoogle Scholar
  9. 9.
    Dauerman HL, Goldberg RJ, White K et al (2002) Revascularization, stenting and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 90:838–842PubMedCrossRefGoogle Scholar
  10. 10.
    Morrow DA, Antman EM, Charlesworth A et al (2000) TIMI risk score for ST elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation. Circulation 102:2031–2037PubMedGoogle Scholar
  11. 11.
    World Health Organization (1968) Nutritional anemias: report of a WHO Scientific Group. World Health Organization, GenevaGoogle Scholar
  12. 12.
    Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470PubMedGoogle Scholar
  13. 13.
    Archbold RA, Balami D, Al-Hajiri A et al (2006) Hemoglobin concentration is an independent determinant of heart failure in acute coronary syndromes: cohort analysis of 2310 patients. Am Heart J 152:1091–1095PubMedCrossRefGoogle Scholar
  14. 14.
    Rao AK, Pratt C, Berke A et al (1988) Thrombolysis In Myocardial Infarction (TIMI) Trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 11:1–11PubMedCrossRefGoogle Scholar
  15. 15.
    de Lemos JA, Braunwald E (2001) ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol 38:1283–1294PubMedCrossRefGoogle Scholar
  16. 16.
    Horwich TB, Fonarow GC, Hamilton MA et al (2002) Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 39:1780–1786PubMedCrossRefGoogle Scholar
  17. 17.
    Gagnon DR, Zhang TJ, Brand F et al (1994) Hematocrit and the risk of cardiovascular disease—the Framingham study: a 34-year followup. Am Heart J 127:674–682PubMedCrossRefGoogle Scholar
  18. 18.
    Marenzi G, Lauri G, Assanelli E et al (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785PubMedCrossRefGoogle Scholar
  19. 19.
    Sharma S, Francis DP, Pitt B et al (2004) Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J 25:1021–1028PubMedCrossRefGoogle Scholar
  20. 20.
    Anand IS, Chandrashekhar Y, Ferrari R et al (1993) Pathogenesis of oedema in chronic severe anemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J 70:357–362PubMedCrossRefGoogle Scholar
  21. 21.
    Fortune JB, Feustel PJ, Saifi J et al (1987) Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 27:243–249PubMedCrossRefGoogle Scholar
  22. 22.
    Wu WC, Rathore SS, Wang Y et al (2001) Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 345:1230–1236PubMedCrossRefGoogle Scholar
  23. 23.
    Nikolsky E, Mehran R, Sadeghi M et al (2009) Prognostic impact of blood transfusion after primary angioplasty for acute myocardial infarction; analysis from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) Trial. J Am Coll Cardiol Intv 2:624–632Google Scholar
  24. 24.
    Casutt M, Seifert B, Pasch T et al (1999) Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 27:2194–2200PubMedCrossRefGoogle Scholar
  25. 25.
    Dietrich KA, Conrad SA, Hebert CA et al (1990) Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 18:940–944PubMedCrossRefGoogle Scholar
  26. 26.
    Twomley KM, Rao SV, Becker RC (2006) Proinflammatory, immunomodulating, and prothrombotic properties of anemia and red blood cell transfusions. J Thromb Thrombolysis 21:167–174PubMedCrossRefGoogle Scholar
  27. 27.
    Vamvakas EC, Blajchman MA (2007) Transfusion-related immunomodulation (TRIM): an update. Blood Rev 21:327–348PubMedCrossRefGoogle Scholar
  28. 28.
    Koch CG, Li L, Sessler DI et al (2008) Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 358:1229–1239PubMedCrossRefGoogle Scholar
  29. 29.
    Rao SV, Jollis JG, Harrington RA et al (2004) Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 292:1555–1562PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Cihan Dündar
    • 1
  • Vecih Oduncu
    • 1
  • Ayhan Erkol
    • 2
  • Ali Cevat Tanalp
    • 3
  • Dicle Sırma
    • 1
  • Ali Karagöz
    • 1
  • Can Yücel Karabay
    • 1
  • Alev Kılıçgedik
    • 1
  • Selçuk Pala
    • 1
  • Kürşat Tigen
    • 1
  • Akın Izgi
    • 1
  • Cevat Kırma
    • 1
  1. 1.Department of CardiologyKosuyolu Heart Education and Research HospitalIstanbulTurkey
  2. 2.Department of CardiologyKocaeli Derince Education and Research HospitalDerinceTurkey
  3. 3.Department of CardiologyMedicana International HospitalAnkaraTurkey

Personalised recommendations