Evaluate The Prediction Of Major Adverse Cardiac Events With The Presence Of Anemia On Admission And The GRACE Risk Score The Prediction For In Patients With Acute Coronary Syndrome

Introduction:Background:In patients admitted for acute coronary syndrome (ACS), the presence of anemia is a predictor of prognosis. However, risk scores used for prognostic stratification do not include this variable.Objectives:To evaluate whether the presence of anemia on admission in patients with ACS has additional value over the GRACE risk score in the prediction of major adverse cardiac events.Methods:Between Match2012and Match2013, we assessed consecutive patients admitted to our intensive care unit for ACS and included in our single-center ACS registry. In all patients information was collected on demographic and anthropometric variables, risk factors for coronary artery disease, and clinical and laboratorial data on admission, including hemoglobin. Patients with anemia were identified (hemoglobin <12g/dl for women and<13g/dl for men). Patients were classified as low, intermediate or high risk on the GRACE risk score (<85,85---133and>133, respectively). In-hospital, one-month and six-month major adverse cardiac events (MACE) were analyzed.Results:The study population included217patients with a mean age of67±years,56.7%male, anemia on admission being present in21.2%. These patients were older and more often female, with a higher proportion of diabetics, and more often had a history of myocardial infarction, worse Killip class on admission and higher GRACE risk score. On the other hand, fewer were smokers, fewer presented ST-segment elevation myocardial infarction and they were less often treated with beta-blockers. one-month (12%vs.5%) and six-month MACE (15%vs.6%) were higher in the anemia group (p<0.001). In bivariate analysis, the presence of anemia was a predictor of in-hospital (OR6.581,95%CI2.565--16.308,p<0.001), one-month (OR6.748,95%CI2.937---15.506, p<0.001) and six-month MACE MACE (OR11.4,95%CI5.347---24.3, p<0.001). After adjustment for other variables, this association was also significant. When we analyzed the presence or absence of anemia for each GRACE risk score group, there were differences in in-hospital,one-month, six-month MACE, using the Receiver Operating Characteristic (ROC) curves.GRACE risk score combine with anemia can improve the value of prediction.Conclusions:Our data confirm that anemia is an important predictor of short-and medium-term MACE after ACS, significant after adjustment or when included in the GRACE risk score. Combining this variable with the GRACE risk score can improve risk stratification.