Key result
Moderate-to-severe anemia in severe AS linked to ~56% higher risk of valve-related death or HF hospitalization.
Why the study?
The prognostic impact of anemia complicating severe aortic stenosis remains unclear.
Does anemia increase the risk of aortic valve-related death or heart failure hospitalization in patients with severe aortic stenosis?
Cohort (n=3,403)
Yes
Does anemia increase the risk of aortic valve-related death or heart failure hospitalization in patients with severe aortic stenosis?
Hazard Ratio: 1.56 (95% CI 1.31–1.87)
Absolute Event Rate: 56% vs 22%
p-value: p=<0.001
In patients with severe aortic stenosis, the presence of mild or moderate/severe anemia is associated with a significantly increased risk of aortic valve-related death or heart failure hospitalization, regardless of whether they undergo initial valve replacement or conservative management.
Anemia may refine risk stratification in severe AS; leaves open whether correction improves outcomes.
Prognostic impact of anemia complicating severe aortic stenosis (AS) remains unclear. We assessed the impact of anemia on cardiovascular and bleeding outcomes in 3403 patients enrolled in the CURRENT AS registry. 835 patients (25%) had mild (hemoglobin 11.0-12.9 g/dl for men/11.0-11.9 g/dl for women) and 1282 patients (38%) had moderate/severe anemia (Hb ≤ 10.9 g/dl) at diagnosis of severe AS. Mild and moderate/severe anemia were associated with significantly increased risks relative to no anemia (hemoglobin ≥13.0 g/dl for men/≥12.0 g/dl for women) for the primary outcome measure (aortic valve-related death or heart failure hospitalization) in the entire population [hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.07-1.57 and HR: 1.56; 95%CI: 1.31-1.87, respectively] and in the conservative management stratum (HR: 1.73; 95%CI: 1.40-2.13 and HR: 2.05; 95%CI: 1.69-2.47, respectively). Even in the initial aortic valve replacement stratum, moderate/severe anemia was associated with significantly increased risk for the primary outcome measure (HR: 2.12; 95%CI: 1.44-3.11). Moreover, moderate/severe anemia was associated with significantly increased risk for major bleeding while under conservative management (HR: 1.93; 95%CI: 1.21-3.06). These results warrant further study to explore whether better management of anemia would lead to improvement of clinical outcomes.
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Nagao et al. (2019) conducted a cohort in Severe Aortic Stenosis (n=3,403). Moderate/severe anemia vs. No anemia (Hb ≥ 13.0 g/dl for men, and ≥12.0 g/dl for women) was evaluated on Composite of aortic valve-related death and heart failure hospitalization (HR 1.56, 95% CI 1.31-1.87, p=<0.001). Moderate to severe anemia at the diagnosis of severe aortic stenosis was associated with a significantly increased risk of aortic valve-related death or heart failure hospitalization (HR 1.56) compared to no anemia.
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