Background:
Hemoglobin decline following acute myocardial infarction (AMI) is associated with long-term morbidity. Since women have lower baseline hemoglobin levels than men, whether the same absolute change in hemoglobin after AMI similarly affects outcomes in women and men is unknown.
Methods:
We examined patients discharged after AMI in the TRIUMPH registry between 2005 and 2008 who had admission and discharge hemoglobin levels. We compared the relationship between absolute change in hemoglobin during hospitalization with 6- and 12-month mortality and re-hospitalization by gender after adjusting for clinical variables including admission hemoglobin.
Results:
Of the 4,243 patients with AMI, 33% (1,400 of 4,243) were women. Women were older, had more co-morbidities, and were less likely to present with STEMI, or receive catheterization. Women had lower admission hemoglobin (12.9 g/dL ± 1.9 vs 14.5 ± 2.0, p= <0.01) and a smaller mean absolute change in hemoglobin during hospitalization (-1.5 g/dL ± 1.8 vs -1.6 ±1.8, p = 0.01) compared to men. The association between hemoglobin declines during hospitalization and mortality and re-hospitalization rates at 6 and 12-months were of a similar magnitude between men and women (all interaction p > 0.05). (Figure 1)
Conclusion:
Although women with AMI had lower admission hemoglobin values, similar declines in hemoglobin during hospitalization were associated with increases in mortality and re-hospitalization in women and men. These findings suggest that absolute change in hemoglobin is equally important at predicting outcomes in women and men, regardless of admission hemoglobin levels.
The relationship between serum rheumatoid factor level and SYNTAX score I in patients with acute myocardial infarction
