Key result
Baseline anemia in acute coronary syndrome patients undergoing percutaneous coronary intervention was associated with a significantly higher rate of 180-day mortality (6.9% vs 2.1%; HR 1.9).
Why the study?
The impact of baseline anemia in a contemporary ACS population undergoing PCI in the era of predominant radial access, potent P2Y12 inhibition, and rare glycoprotein IIb/IIIa inhibitor use has not been adequately studied.
Does baseline anemia increase the risk of mortality, myocardial reinfarction, and major bleeding in ACS patients undergoing percutaneous coronary intervention?
Cohort (n=5,482)
Open-label
Yes
Does baseline anemia increase the risk of mortality, myocardial reinfarction, and major bleeding in ACS patients undergoing percutaneous coronary intervention?
Baseline anemia in ACS patients undergoing contemporary PCI is a high-risk feature associated with significantly increased 180-day mortality, myocardial reinfarction, and major bleeding.
Anemia flags higher short-term mortality risk in ACS-PCI; leaves open whether correction improves outcomes.
Background The impact of baseline anemia in a contemporary acute coronary syndrome (ACS) population undergoing percutaneous coronary intervention in the era of predominant radial artery access, potent P2Y12 inhibition, and rare use of glycoprotein IIb/IIIa inhibitors has not been adequately studied. Methods and Results ACS patients who underwent percutaneous coronary intervention between 2014 and 2016 in the VALIDATE-SWEDEHEART (Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry) trial without missing values for hemoglobin were included (n=5482). Mortality, myocardial reinfarction, and major bleeding at 180 days were assessed using Cox regression models and propensity score matching. All studied comorbidities were more common in ACS patients who had anemia (n=792). ACS patients with anemia had higher rates of 180-day mortality (6.9% versus 2.1%; hazard ratio, 1.9; 95% CI, 1.3-2.7; P<0.001), myocardial reinfarction (4.3% versus 1.9%; hazard ratio, 1.7; 95% CI, 1.1-2.7; P=0.013), and major bleeding (13.4% versus 8.2%; hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.041). The results were most evident in patients with a hemoglobin value <100 g/L, who had a nearly 10 times higher mortality rate. Conclusions Baseline anemia in ACS patients undergoing percutaneous coronary intervention, treated according to current practice including routine radial artery access, constitutes a high-risk feature for both ischemic events, bleeding events, and mortality. A multidisciplinary approach is warranted to maximize benefit and minimize patient risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02311231.
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Wester et al. (2019) conducted a cohort in Acute Coronary Syndromes (ACS) (n=5,482). Baseline anemia vs. No anemia was evaluated on Death from any cause at 180 days (HR 1.9, 95% CI 1.3-2.7, p=<0.001). Baseline anemia in acute coronary syndrome patients undergoing percutaneous coronary intervention was associated with a significantly higher rate of 180-day mortality (6.9% vs 2.1%; HR 1.9).
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