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Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome

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Abstract

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 ≥0.9 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 ≥2 (p = 0.009), anemia (p = 0.0064), decreased estimated glomerular filtration rate (p = 0.003), and hemoglobin decline ≥0.9 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 non-bleeding ACS patients. A decline in hemoglobin ≥0.9 g/dl identifies high-risk patients. Identification of these patients refines the prognostic value of the GRACE score.

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Authors and Affiliations

  1. Cardiology Department, Groupement Hospitalier Saint Philibert, Faculté libre de médecine de Lille, rue du grand but, Lomme, 59160, Lille Cedex, France

    Sylvestre Maréchaux

  2. Institut Fédératif de Recherche 114, EA 2693, Université Lille Nord de France, 59000, Lille Cedex, France

    Sylvestre Maréchaux, Francis Juthier, Carlo Banfi, Sophie Susen, Brigitte Jude, Eric Van Belle & Pierre Vladimir Ennezat

  3. Intensive Cardiology Care Unit, Emergency Departments, Centre Hospitalier Régional et Universitaire de Lille, Lille Cedex, France

    Stéphanie Barrailler, Vincent Decourcelle, Thomas Guidez, Sophie Braun, Nadia Bouabdallaoui, Jean-Jacques Bauchart, Jean Luc Auffray, Philippe Asseman, Eric Van Belle & Pierre Vladimir Ennezat

  4. Department of Biostatistics, Faculté de Pharmacie de Lille, UDSL, EA 2694, Lille Cedex, France

    Claire Pinçon

  5. Intensive Care Unit, Cardiac Catheterization Laboratory, Hôpital Cardiologique, Bd Pr J Leclercq, 59037, Lille Cedex, France

    Eric Van Belle & Pierre Vladimir Ennezat

Authors
  1. Sylvestre Maréchaux
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  2. Stéphanie Barrailler
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  3. Claire Pinçon
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  4. Vincent Decourcelle
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  6. Sophie Braun
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  7. Nadia Bouabdallaoui
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  8. Jean-Jacques Bauchart
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  9. Jean Luc Auffray
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  10. Francis Juthier
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  11. Carlo Banfi
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  12. Sophie Susen
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  13. Brigitte Jude
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  14. Philippe Asseman
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  15. Eric Van Belle
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  16. Pierre Vladimir Ennezat
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Corresponding authors

Correspondence to Eric Van Belle or Pierre Vladimir Ennezat.

Additional information

S. Maréchaux and S. Barrailler equally contributed to the manuscript.

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Maréchaux, S., Barrailler, S., Pinçon, C. et al. Prognostic value of hemoglobin decline over the GRACE score in patients hospitalized for an acute coronary syndrome. Heart Vessels 27, 119–127 (2012). https://doi.org/10.1007/s00380-011-0127-3

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  • DOI: https://doi.org/10.1007/s00380-011-0127-3

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