Association between iron status biomarkers and prognosis after acute coronary syndrome

Samar Mahmoud, MS | January 26, 2022

Iron deficiency is a frequent co-morbidity in heart failure patients and has been linked to an increased risk of death and lower quality of life.


Study Design

This study enrolled 844 patients, aged >40 years, who were hospitalized for ACS, in the Netherlands between 2008 and 2015. Patients underwent repeat venipuncture during the year after hospitalization, including upon hospital admission, discharge, as well as every two weeks during the first 6 months and once a month thereafter. 

The primary outcome of the study was a composite endpoint of cardiovascular death and repeat nonfatal ACS, including unstable angina pectoris requiring revascularization. 

Investigators analyzed the correlation between iron status and the primary endpoint using multivariable joint models. 

Results and Conclusions

The average participant age was 63 years and males comprised 78%  of subjects. 

Repeated measurements of iron and TSAT were significantly associated with the primary endpoint of cardiovascular death and repeat nonfatal ACS, while ferritin and transferrin were not. 

A 1 SD decrease in log-iron and log-TSAT was associated with a 2.2-fold and 1.78-fold increased risk of the primary endpoint, respectively. 

Upon removal of the initial 30 days post hospitalization from the analysis, iron and TSAT were no longer found to be significantly associated with the primary endpoint. 

Related Research

Consider these findings from similar research studies:

  • Acute coronary syndrome patients with iron deficiency have worse long-term outcomes (Source). 

  • TSAT and serum iron levels predict heart failure patients most at risk of cardiovascular death (Source).