European Heart Journal Advance Access published online on October 12, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp401
Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes
1 Department of Cardiology, University Hospital Jean Minjoz, EA 3920, 25000 Besançon, France
2 Population Health Research Institute, McMaster University, Hamilton, Canada
3 McMaster University, Hamilton, Canada
4 Uppsala Clinical Research Centre, University Hospital Uppsala, Uppsala, Sweden
5 Academic Medical Center, Amsterdam, The Netherlands
6 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
7 Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
8 Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
9 Duke Clinical Research Institute, Durham, NC, USA
Received 14 August 2008; revised 10 July 2009; accepted 15 September 2009 * Corresponding author. Tel: +33 381 668 539, Fax: +33 381 668 582; E-mail: jpbassan{at}univ-fcomte.fr
Aims: In patients with acute coronary syndromes (ACS), the negative impact of baseline haemoglobin levels on ischaemic events, particularly death, is well established, but the association with bleeding risk is less well studied. The aim of this study was to assess the impact of baseline haemoglobin levels on major bleeding complications.
Methods and results: Pooled analysis of OASIS 5 and 6 data involving 32 170 patients with ACS with and without ST-segment elevation was performed. The association between baseline haemoglobin and major bleeding or ischaemic events was examined using multiple regression model. Main outcome measures were 30-day rates of major bleeding, death, and death/myocardial infarction (MI) analysed according to baseline haemoglobin levels. Baseline haemoglobin level independently predicted the risk of overall, procedure-related, and non-procedure-related major bleedings at 30 days [odds ratio (OR) 0.94, 95% CI 0.90–0.98; OR 0.94, 95% CI 0.90–0.99; and OR 0.89, 95% CI 0.83–0.95, respectively, per 1 g/dL haemoglobin increment above 10 g/dL]. In addition, a curvilinear relationship between baseline haemoglobin levels and death at 30 days was observed with a 6% decrease in the risk for every 1 g/dL haemoglobin increment above 10 g/dL up to 15.9 g/dL (OR 0.94, 95% CI 0.90–0.98) and a 19% increase above this value (OR 1.19, 95% CI, 0.98–1.43). A similar relationship for the composite outcome of death/MI was observed.
Conclusion: A low baseline haemoglobin level is an independent predictor of the risk of major bleeding in ACS as well as of the risk of death and death and MI. Among other predictors of bleeding risk, baseline haemoglobin should be taken into account in patients presenting with ACS.
Clinical trial registration: ClinicalTrials.gov number, NCT00139815 [ClinicalTrials.gov] .
http://clinicaltrials.gov/ct2/show/NCT00139815?term=NCT00139815&rank=1.
Key Words: Anaemia • Angina • Anticoagulants • Infarction