The predictive value of low admission hemoglobin over the GRACE score in patients with acute coronary syndrome

Abstract

A B S T R A C TBackground: The GRACE risk score is currently recommended as the major score for risk prediction on admission in patients with acute coronary syndrome (ACS). Anemia in patients with ACS adversely affects their clinical outcomes, yet hemoglobin level on admission is not included as a parameter in the GRACE score. We hypothesized that hemoglobin level on admission would improve the predictive value of the GRACE score. Methods: We retrospectively studied one-year mortality in consecutive ACS patients included in the ACSIS (acute coronary syndrome Israeli Survey) registry between the years 2008 and 2013. Patients were classified into groups according to the GRACE score -!140 or <140, and according to the hemoglobin level: severe anemia -<8 g/dl; mild anemia -8-12 g/dl; no anemia ->12 g/dl. We analyzed the incremental predictive value of admission hemoglobin levels over the GRACE score. Results: We studied 11,505 patients. The GRACE score predicted 1-year mortality with an area under the curve (ROC) of 0.68 (95% CI 0.66-0.7). When hemoglobin level on admission was incorporated into the model, the ROC increased to 0.73 (95% CI 0.71-0.75, p < 0.001). The incremental value of hemoglobin levels on admission was significant only in the low (<140) GRACE score group. Conclusions: In patients a with low GRACE score (<140), anemia on admission has additional predictive value for one-year mortality. In contrast, in patients with a high GRACE risk score, hemoglobin level on admission did not improve prediction accuracy.

Characteristics of In-Hospital Mortality among Patients with Acute Coronary Syndrome: A Single-Center Study in West Java, Indonesia

“…15 Furthermore, anemia (Hb <12 g/ dl) on admission is associated with increased mortality in ACS patients. 16,17 However, the mean Hb concentration found in this study is in the normal range.…”

A Novel ABC Score Predicts Mortality in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Who underwent Percutaneous Coronary Intervention

“…21 Moady et al's study suggested that in patients with a low GRACE score (<140), anemia on admission has additional predictive value for 1-year mortality. 22 Chattopadhyay et al also established an adjusted GRACE score by adding 2-hour postload glucose, which can improve prediction of long-term major adverse cardiac events in ACS patients without known diabetes. 23 Cordero et al integrated the CRUSADE and GRACE scores to estimate mortality risk and found the predictive power to be significantly improved.…”

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

“…A number of previous studies show that the GRS has a predictable probability for MACE composited of death and MI. [ 5 , 10 , 14 , 41 ] Although the study by Fan et al of Chinese STEMI patients finds some association between the GRS and complex cardiovascular events, [ 42 ] our study finds the predictive ability of the GRS on multiple major adverse events to remain inadequate and further work is required. Nevertheless, the disparity between our and Fan et al results could be due to the lower rate of cardiovascular death and MACE in our center, which is owed by the timely reperfusion and complete revascularization in accordance with current guidelines and management of STEMI.…”