Relation of Iron Status to Prognosis After Acute Coronary Syndrome
Gürgöze, Muhammed T; Kardys, Isabella; Akkerhuis, K Martijn; Oemrawsingh, Rohit M; Groot, Hilde E; van der Harst, Pim; Umans, Victor A; Kietselaer, Bas; Ronner, Eelko; Lenderink, Timo; Asselbergs, Folkert W; Manintveld, Olivier C; Boersma, Eric
(2022) The American Journal of Cardiology, volume 168, pp. 22 - 30
(Article)
Abstract
Iron deficiency has been extensively researched and is associated with adverse outcomes in heart failure. However, to our knowledge, the temporal evolution of iron status has not been previously investigated in patients with acute coronary syndrome (ACS). Therefore, we aimed to explore the temporal pattern of repeatedly measured iron, ferritin,
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transferrin, and transferrin saturation (TSAT) in relation to prognosis post-ACS. BIOMArCS (BIOMarker study to identify the Acute risk of a Coronary Syndrome) is a prospective, multicenter, observational cohort study conducted in The Netherlands between 2008 and 2015. A total of 844 patients with post-ACS were enrolled and underwent high-frequency (median 17) blood sampling during 1 year follow-up. Biomarkers of iron status were measured batchwise in a central laboratory. We analyzed 3 patient subsets, including the case-cohort (n = 187). The primary endpoint (PE) was a composite of cardiovascular mortality and repeat nonfatal ACS, including unstable angina pectoris requiring revascularization. The association between iron status and the PE was analyzed using multivariable joint models. Mean age was 63 years; 78% were men, and >50% had iron deficiency at first sample in the case-cohort. After adjustment for a broad range of clinical variables, 1 SD decrease in log-iron was associated with a 2.2-fold greater risk of the PE (hazard ratio 2.19, 95% confidence interval 1.34 to 3.54, p = 0.002). Similarly, 1 SD decrease in log-TSAT was associated with a 78% increased risk of the PE (hazard ratio 1.78, 95% confidence interval 1.17 to 2.65, p = 0.006). Ferritin and transferrin were not associated with the PE. Repeated measurements of iron and TSAT predict risk of adverse outcomes in patients with post-ACS during 1 year follow-up. Trial Registration: The Netherlands Trial Register. Unique identifiers: NTR1698 and NTR1106. Registered at https://www.trialregister.nl/trial/1614 and https://www.trialregister.nl/trial/1073.
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Keywords: Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 0002-9149
Publisher: Elsevier Inc.
Note: Funding Information: The BIOMArCS study was supported and funded by The Netherlands Heart Foundation, grant number 2007B012 (Utrecht, The Netherlands), The Netherlands Heart Institute-Interuniversity Cardiology Institute of Netherlands, project number 071.01 (Utrecht, The Netherlands), and the Working Group of Cardiovascular Research Netherlands, all of which are noncommercial funding bodies. An unrestricted research grant was further obtained from Eli Lilly (Utrecht, The Netherlands). Dr. Asselbergs is supported by UCL Hospitals NIHR Biomedical Research Center (London, United Kingdom). Funding Information: The authors would like to thank all participating centers for carrying out the study procedures and data collection. The BIOMArCS study was supported and funded by The Netherlands Heart Foundation, grant number 2007B012 (Utrecht, The Netherlands), The Netherlands Heart Institute-Interuniversity Cardiology Institute of Netherlands, project number 071.01 (Utrecht, The Netherlands), and the Working Group of Cardiovascular Research Netherlands, all of which are noncommercial funding bodies. An unrestricted research grant was further obtained from Eli Lilly (Utrecht, The Netherlands). Dr. Asselbergs is supported by UCL Hospitals NIHR Biomedical Research Center (London, United Kingdom). Publisher Copyright: © 2022 The Authors
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