Key result
Baseline anemia is linked to ~94% higher 1-year mortality in patients with ACS and AF.
Why the study?
The added discriminatory power of including anemia in the CHA2DS2-VASc score for poor prognosis in patients with acute coronary syndromes and atrial fibrillation remained unclear.
Does anemia increase the risk of adverse outcomes and does adding hemoglobin to the CHA2DS2-VASc score improve predictive accuracy in patients with acute coronary syndrome and atrial fibrillation?
Cohort (n=1,166)
No
Does anemia increase the risk of adverse outcomes and does adding hemoglobin to the CHA2DS2-VASc score improve predictive accuracy in patients with acute coronary syndrome and atrial fibrillation?
Hazard Ratio: 1.935 (95% CI 1.106–3.384)
Absolute Event Rate: 16.5% vs 3.7%
p-value: p=0.021
Anemia is an independent predictor of 1-year mortality and MACE in patients with combined ACS and AF, and adding hemoglobin levels to the CHA2DS2-VASc score enhances its prognostic capability.
Anemia flags higher 1-year mortality risk in ACS-AF; supports hemoglobin-augmented CHA2DS2-VASc but leaves causal benefit open.
Patients with acute coronary syndromes (ACS) and atrial fibrillation (AF) have more complex conditions, making risk stratification crucial. The added discriminatory power of including anemia in the CHA 2 DS 2 -VASc ([congestive heart failure, hypertension, age [>65 = 1 point, >75 = 2 points], diabetes, previous stroke/systemic embolism/transient ischemic attack [2 points], vascular disease, age 65–74 years, and sex category]) score for poor prognosis in this population remains unclear. This study investigates the impact of anemia on 1166 patients with ACS and AF from 2017 to 2019. Multivariate Cox regression analysis showed anemia significantly increased the risk of all-cause mortality (Hazard ratio [HR] = 1.935, 95% CI: 1.106–3.384, P = .021) and major adverse cardiovascular events (MACE; HR = 1.857, 95% CI: 1.171–2.945, P = .009), but not thromboembolic events (HR = 0.651, 95% CI: 0.210–2.022, P = .458). Receiver operating characteristic (ROC) curves showed that hemoglobin’s area under the curve (AUC) for mortality and MACE was 0.722 and 0.710, respectively, improving to 0.770 and 0.772 when combined with the CHA 2 DS 2 -VASc score. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) metrics showed significant improvement in predicting mortality (NRI = 0.258, P = .004; IDI = 0.037, P < .001) and MACE (NRI = 0.232, P = .002; IDI = 0.026, P = .004). Adding hemoglobin to the CHA 2 DS 2 -VASc score enhances its predictive performance.
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Shu et al. (2025) conducted a cohort in Acute Coronary Syndrome and Atrial Fibrillation (n=1,166). Anemia vs. Non-anemia was evaluated on 1-year all-cause death (HR 1.935, 95% CI 1.106-3.384, p=0.021). In patients with acute coronary syndrome and atrial fibrillation, baseline anemia was significantly associated with an increased risk of 1-year all-cause mortality (HR 1.935) and major adverse cardiovascular events.
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