Elsevier

American Heart Journal

Volume 152, Issue 5, November 2006, Pages 991-996
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Anemia as independent predictor of major events in elderly patients with chronic angina

https://doi.org/10.1016/j.ahj.2006.06.014Get rights and content

Background

Anemia correlates with worse outcome in patients with heart failure, after myocardial infarction or angioplasty. Its prevalence increases with age, but the influence of anemia on outcome of elderly patients with stable symptomatic coronary artery disease (CAD) is unknown. Therefore, we assessed the impact of anemia on long-term outcome in elderly patients with CAD.

Methods

Hemoglobin-related outcome was examined in 253 patients of the TIME study. Patients ≥75 years old were randomly assigned to an invasive or optimized medical strategy and followed for a median of 4 years for death, nonfatal myocardial infarction, or hospitalization for CAD. Depending on their hemoglobin (Hb) level, patients were divided in quartiles (Q). Anemia was defined as Hb <13 g/dL for men and <12 g/dL for women.

Results

Compared with nonanemic patients, those with previously unknown anemia were older (79 ± 3 vs 80 ± 4 years, P < .01), had more chronic renal failure (6.7% vs 26.4%, P < .01), diabetes (18.9% vs 30.1%, P = .05), and were more likely to have >2 comorbidities (21.7% vs 38.4%, P < .01). After adjustment for baseline differences, a decrease in 1 g/dL Hb increased the risk of all-cause death by 34% (adjusted risk ratio 1.34, P < .01), of cardiac death by 28% (adjusted risk ratio 1.28, P = .02), and of major adverse clinical events in patients with Hb levels <13.3 g/dL by 23% (adjusted risk ratio 1.23, P = .01).

Conclusion

Anemia proved to be an independent predictor of death and major clinical adverse events among elderly patients with stable symptomatic CAD.

Section snippets

Patients

We retrospectively examined the Hb-related outcome in 253 of 301 patients with available Hb values taking part in the TIME study. Details of this study have been described previously.9 In short, in this prospective randomized multicenter Swiss trial, 301 patients aged ≥75 years with chronic angina Canadian Cardiac Society class ≥2 despite medical treatment with at least 2 antianginal drugs were randomized to an optimal medical therapy or an invasive strategy with coronary angiography followed

Baseline characteristics

Baseline characteristics are summarized in Table I. The median age of the 253 patients was 79.1 years; 43% were women, 50% had a history of MI, and 15% a history of congestive heart failure. Chronic renal failure was present in 12% of cases and 27% of patients were affected by ≥2 relevant comorbidities. Compared with patients with available Hb values (n = 253), those without (n = 48) did not differ in any baseline characteristics except for a history of previous MI (33% vs 49%, P = .041).

Anemic

Discussion

This study shows that previously unknown mild to moderate anemia is a highly prevalent condition and an independent predictor of long-term outcome among elderly patients with stable symptomatic CAD. The data showed a marked increase of anemia prevalence with advancing age, suggesting that this patient collective is at special risk in this regard. The impact of anemia on clinical outcome was dependent on the severity of Hb reduction. Patients of the lowest Hb quartile had a significantly worse

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    • Cited by (0)

    The TIME study has been supported by grants from the Swiss Heart Foundation, Berne, Switzerland, and the Adumed Foundation, Zurich, Switzerland.

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