Anemia in Acute Coronary Syndrome patients increases mortality risks after PCI: JAHA

Baseline anemia in Acute Coronary Syndromes (ACS) patients increases mortality risks after undergoing a Percutaneous Coronary Intervention (PCI), according to a study published in the Journal of the American Heart Association (JAHA).

The study showed that baseline anemia among patients with ACS undergoing PCI is associated with a significantly increased risk of ischemic events, bleeding events, and mortality. Further effort is required to reduce the risk in this population.

Patients with anemia are often elderly, female, with a low body mass index (BMI), and have a higher prevalence of cardiovascular risk factors such as diabetes and chronic kidney disease. It is a common problem in patients hospitalized for Coronary Artery Disease. Studies have established the association between low baseline hemoglobin and the risk of major ischaemic adverse events.

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 have not been adequately studied. Therefore, the present study sought to ascertain the effects of baseline anemia in acute coronary syndromes patients undergoing PCI.

To achieve this, the authors included 5482 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. Mortality, myocardial reinfarction, and major bleeding at 180 days were assessed using Cox regression models and propensity score matching.

Key observations

• 792 ACS patients who had anemia had common comorbidities.


• ACS patients with anemia had higher rates of 180-day mortality, myocardial reinfarction, major bleeding.


• The results were most evident in patients with a hemoglobin value <100 g/L, who had a nearly 10 times higher mortality rate.

On the basis of their results, the authors concluded that 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.

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