Impact of moderate to severe anemia on clinical outcomes in patients with atrial fibrillation and coronary artery disease requiring percutaneous coronary intervention

Abstract

Abstract Background In patients with coronary artery disease undergoing percutaneous coronary intervention (PCI), anemia is one of the important risk factors for thrombotic events as well as bleeding events. In patients with atrial fibrillation (AF), on the other hand, a similar relationship between anemia and the increased risks of mortality, cardiovascular events, or bleeding events has been reported. Purpose The purpose of this study was to evaluate the impact of anemia on clinical outcomes in patients with AF undergoing PCI, who required intensive antithrombotic therapy with a combination of anticoagulants and antiplatelet agents, using a multicenter registry database. Methods Patients with AF undergoing PCI at 15 institutions between January 2015 and March 2021 were included in this analysis. Based on the baseline hemoglobin levels, moderate to severe anemia was defined as hemoglobin levels <11 g/dL, and mild anemia was defined as hemoglobin levels 11-12.9 g/dL for men and 11-11.9 g/dL for women. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, stent thrombosis, and stroke) and major bleeding events (BARC 3 or 5), were compared among patients with moderate/severe anemia, mild anemia, and no anemia. Results In a total of 746 enrolled patients, 119 (16.0%) and 168 (22.5%) patients presented with moderate/severe and mild anemia. The incidence of MACE (22.5%, 11.0%, and 9.1%, log-rank p<0.001) as well as major bleeding events (10.7%, 6.5%, and 2.7%, log-rank p<0.001) was the highest in the moderate/severe anemia group compared with the mild and no anemia groups (Figure 1). In multivariable Cox regression analyses, moderate/severe anemia (p=0.008), severe chronic kidney disease (p=0.019), and acute coronary syndrome (p=0.049) were independently associated with MACE. For major bleeding events, moderate/severe anemia (p=0.031) and platelet count (p=0.021) were independent predictors. Conclusions Moderate/severe anemia was significantly associated with the higher incidence of MACE as well as major bleeding events compared with mild and no anemia in AF patients undergoing PCI.Figure 1