Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India.

Anjalee Chiwhane,Shreerang Burchundi,Gajendra Manakshe,Hemant Kulkarni

doi:10.5334/gh.527

Abstract

Background:Anemia is highly prevalent in low- and middle-income countries, where prevalence of acute coronary syndrome (ACS) is also rising. Evidence indicates that baseline anemia status can prognosticate ACS. However, the Global Registry of Acute Coronary Events (GRACE) score that is popularly used all over the world does not include information on anemia.Objectives:Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS.Methods:We enrolled 200 ACS patients at the Acharya Vinoba Bhave Rural Hospital—a rural, tertiary care hospital in central India. Patients were followed for 6 months for death and major adverse cardiac event (MACE). Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI).Results:There were 31 deaths due to MACE and an additional 28 non-fatal MACE events during follow-up. Baseline hemoglobin was strongly and independently associated with both outcomes even after adjusting for a multivariable propensity score. For the outcome of death and death/MACE there was a moderate improvement in the AUC of 1% and 6%, respectively. However, for these outcomes the IDI for baseline hemoglobin was 6% (p = 0.03) and 12% (p << 0.0001), respectively, while the NRI was 0.50 (p = 0.01) and 0.78 (p << 0.0001), respectively.Conclusions:Inclusion of baseline anemia in addition to the GRACE score improves prognostication of ACS patients.

Highlights

Acute coronary syndrome (ACS) represents a grim challenge to global cardiovascular health
This study focused on two primary outcomes: a) death during six months of index admission and b) death or the first major adverse cardiac event (MACE) during six months of index admission
The optimum operating point (OOP) for the Global Registry of Acute Coronary Events (GRACE) scores was determined as the point on the receiver operating characteristic curve (ROC) that was closest to the upper-left corner of the ROC plot

Summary

Introduction

Acute coronary syndrome (ACS) represents a grim challenge to global cardiovascular health. Two-thirds of the DALYs and half of the IHD-related deaths occur in low- and middle-income countries (LMIC) [3]. In this context, it is noteworthy that low socioeconomic status has been identified as a significant risk factor for occurrence and consequences of ACS in countries like India [3,4,5]. Objectives: Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS. Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI). Conclusions: Inclusion of baseline anemia in addition to the GRACE score improves p rognostication of ACS patients

Objectives

Methods

Results

Discussion

Conclusion