Key result
Each 1-g/dl increment in baseline hemoglobin level was associated with a decreased risk of 1-year mortality in anemic STEMI patients (HR 0.788) but an increased risk in those with erythrocytosis (HR 2.302).
Why the study?
Does baseline hemoglobin level (anemia or erythrocytosis) and its increment affect 30-day and 1-year mortality in STEMI patients undergoing primary PCI?
Cohort (n=951)
No
Does baseline hemoglobin level (anemia or erythrocytosis) and its increment affect 30-day and 1-year mortality in STEMI patients undergoing primary PCI?
In STEMI patients undergoing primary PCI, higher hemoglobin levels are associated with decreased 1-year mortality in anemic patients but increased 1-year mortality in those with erythrocytosis.
Answers are grounded in this paper and cite their sources.
U-shaped hemoglobin-mortality link in STEMI warrants caution on uniform targets; leaves open randomized trials of individualized thresholds.
BACKGROUND: The association between hemoglobin (Hb) levels and mortality in patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. The purpose of this study was to examine the mortality among STEMI patients with anemia or erythrocytosis, and further establish the relationship between mortality and the increment of Hb level. METHODS: Between 2006 and 2012, 951 consecutive patients with STEMI undergoing primary percutaneous coronary intervention in a medical center in Northern Taiwan were enrolled in our study, including 535 patients with normal Hb level, 148 with anemia (male Hb ≤ 13 g/dl, female ≤ 12) and 268 with erythrocytosis (male Hb ≥ 16, female ≥ 15). RESULTS: Patients in the anemia group were the oldest, and had higher morbidity than the normal Hb group, followed by the erythrocytosis group. In regression analyses, neither anemia nor erythrocytosis was associated with 30-day and 1-year mortality. Each 1-g/dl increment of Hb level was not associated with 30-day mortality both in patients with anemia or erythrocytosis. However, it was associated with a decreased risk of 1-year mortality in anemic patients [hazard ratio (HR): 0.756, 95% confidence interval (CI): 0.608-0.938, p = 0.011] and an increased risk of 1-year mortality in those with erythrocytosis (HR: 2.086, 95%CI: 1.106-3.937, p = 0.023). In multivariate analysis, each 1-g/dl increment of Hb level was associated with 1-year mortality both in anemic patients and those with erythrocytosis (HR: 0.788, 95%CI: 0.621-0.999, p = 0.049; HR: 2.302, 95%CI: 1.051-5.04, p = 0.037). CONCLUSIONS: Higher hemoglobin levels in STEMI patients with anemia were associated with decreased risks of 1-year mortality, whereas higher hemoglobin levels in those with erythrocytosis were associated with increased risks of one-year mortality.
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Liu et al. (2016) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=951). 1-g/dl increment in baseline hemoglobin level vs. lower hemoglobin level was evaluated on 1-year mortality (per 1-g/dl increment in Hb in anemic patients) (HR 0.788, 95% CI 0.621-0.999, p=0.049). Each 1-g/dl increment in baseline hemoglobin level was associated with a decreased risk of 1-year mortality in anemic STEMI patients (HR 0.788) but an increased risk in those with erythrocytosis (HR 2.302).
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