Abstract 12413: Haemoglobin and Change in Haemoglobin Status Predict Mortality, Cardiovascular Events and Bleeding in Stable Coronary Artery Disease: A Clarify Registry Analysis of 21,829 Patients From 45 Countries

Abstract

Anaemia is a predictor of adverse outcome in patients with acute myocardial infarction and those undergoing revascularisation. Little is known regarding the relationship of hemoglobin (Hb) or its change over time on outcomes in patients with CAD. The CLARIFYregistry provides a unique contemporary opportunity to explore this relationship . Methods: 33 283 patients from 45 countries were enrolled in the CLARIFY registry of stable CAD (Nov 2009 -July 2010). Hb values were available for 21,829 patients, who were divided into groups according to Hb quintiles and anaemia status (WHO criteria) at each of baseline and follow-up (anaemic[A]/normal[N]) (status at baseline/follow-up): (i) N/N (ii) A/N (iii) N/A, (iv) A/A. Results: (Table) Whilst patients with lower Hb were less commonly treated with aspirin and ACEIs, they more commonly received thienopyridines, anticoagulants and ARBs. Low Hb was a consistent predictor of mortality, adverse CV event and major bleeds after controlling for various factors at baseline. Anaemia at follow up was independently associated with higher all-cause mortality (p<0.001, HR 1.9 [1.5, 2.3] for A/A and 1.9 [1.5, 2.3] for N/A), non-CV mortality (p<0.001) and CV mortality (p = 0.001). Patients whose baseline anaemia normalised during follow-up (A/N) did not appear to be at increased risk of death (HR 1.0 [0.8, 1.3], although risk of major bleeding was greater (HR 2.1 [1.2, 3.4], p=0.01). Sensitivity analyses were performed after excluding patients with heart failure and chronic kidney disease at baseline and yielded qualitatively similar results. Conclusions: In this large contemporary stable CAD population, low Hb was an independent predictor of mortality, adverse CV event and major bleeds. Persisting or new onset anaemia is a powerful predictor of CV and non-CV mortality. Whilst low Hb may play a pathophysiological role in CV disease progression, the data suggest that it is also likely to be a marker of other co-morbid disease.