1. Anemia Is Associated With Increased One-Year Mortality and Ischemic Events in Patients With ACS: Results From the ACUITY Trial
Steven V. Manoukian, George D. Dangas, Michele D. Voeltz, Frederick Feit, Roxana Mehran, and Gregg W. Stone
Emory University School of Medicine, Atlanta, GA; Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY; New York University School of Medicine, New York, NY

2. STUDY DESIGN
The ACUITY Trial randomized 13,819 patients with moderate and high-risk NSTE-ACS.
UFH or
Enoxaparin
+ GP IIb/IIIa
Bivalirudin
Alone R*
Angiography within 72h
Medical
management
Moderate-
high risk
ACS
PCI
Aspirin in all
Clopidogrel
dosing and timing
per local practice
CABG

3. ACUITY Primary Results – 30 Days
PNI = 0.011
PSup = 0.32
PNI <0.001
PSup <0.001
PSup = 0.015

4. ACUITY Primary Results – 1 Year

5. BACKGROUND & OBJECTIVES
Baseline anemia is associated with an increased risk of short-term (30-day) ischemic complications and mortality in ACS. Whether anemia adversely impacts long-term outcomes is less clear.
Anemia was defined using WHO criteria:
- hgb <13 g/dL men
- hgb <12 g/dL women
We assessed the impact of anemia on rates of long-term (1-year) ischemic events and mortality in patients with ACS in the ACUITY trial.

6. Baseline Characteristics
Anemic (N=2,200, 16.9%)
Non-Anemic (N=10,839, 83.1%)
P value
Age (median [range], yrs)
68 (23, 95)
62 (20, 92)
<0.0001
Male
64.6
71.3
Weight (median [IQR], kg)
82 (70, 94)
84 (73, 95)
Diabetes
42.9
24.7
Hypertension
79.3
64.5
Hyperlipidemia
65.7
55.3
Current smoker
17.1
31.5
Prior MI
36.6
30.1
Prior PCI
49.7
36.8
Prior CABG
24.1
16.5
Hemoglobin (mean)
11.6
14.5
Baseline CrCl <60 mL/min
33.5
16.2
CKMB/Troponin 
55.4
60.0

7. Anemic vs Non-Anemic Population
30-Day Event Rates
P=<0.0001

8. Anemic vs Non-Anemic Population: 1-Year Ischemic Event Rates

9. 30-Day Event Rates by Treatment
Anemic Population
30-Day Event Rates by Treatment
P=0.74
P=0.59
P=0.71
P=0.77
P=0.052
P=0.81

10. Anemic vs Non-Anemic Population:
1-Year Mortality
P<0.0001

11. Predictors of 1-Year Mortality
Baseline Independent
Predictors of 1-Year Mortality
HR ±95% CI
HR (95% CI)
Age (≥75 years)
2.66 ( )
Anemia
1.61 ( )
Baseline CrCl <60 mL/min
1.55 ( )
Prior CVA
1.44 ( )
CKMB/Troponin+
1.77 ( )
ECG changes
1.87 ( )
History of CAD
1.35 ( )
Diabetes
1.61 ( )
Male gender
1.43 ( )

12. CONCLUSIONS Anemia is not uncommon in patients with ACS (16.9%).
Anemia is associated with a significant increase in rates of long-term (1-year) ischemic events.
Anemia is associated with an over 2-fold increase in rates of long-term (1-year) mortality and is an independent predictor of long-term (1-year) mortality in patients with ACS.