Highlights
- •Anemia is a frequent comorbidity in acute coronary syndrome (ACS) patients.
- •In this observational ACS registry, anemia was present in 25.9% patients.
- •Novel P2Y12 inhibitors were significantly less prescribed in anemic patients.
- •Anemia was independently associated with major bleeding and all-cause mortality.
- •Anemic patients taking clopidogrel suffered more mortality events.
Abstract
Background
Anemia is frequent in acute coronary syndrome (ACS) patients and is associated with
worse clinical outcomes. We aimed to investigate the therapeutic strategies, the use
of novel P2Y12 inhibitors, and the prognostic implication of anemia in a “real world” cohort of
ACS patients.
Methods
This is an observational and prospective registry including 1717 ACS patients from
three tertiary hospitals. During hospitalization we recorded the clinical management
and the antiplatelet therapy at discharge. Patients were divided into 2 groups according
to the baseline hemoglobin level, i.e. anemic (hemoglobin < 13 g/dL in men and <12 g/dL
in women) and non-anemic patients. Bleeding events, mortality and major adverse cardiovascular
events (MACEs) were recorded during 1-year of follow-up.
Results
Anemia was present in 445 (25.9%) patients. Cardiac catheterization (83.8% vs. 94.5%,
p < .001), and revascularization by percutaneous coronary intervention (53.5% vs.
70.5%, p < .001) were less frequent in these patients. Excluding anticoagulated patients,
novel P2Y12 inhibitors were less prescribed in anemic patients (OR 2.80 [95% CI 2.13–3.67], p < .001).
Anemia was independently associated with major bleeding (HR 2.26 [95% CI 1.07–4.78],
p = .033) and all-cause mortality (HR 1.62 [95% CI 1.03–2.56], p = .038), but not
with MACE. At 1-year of follow-up, the risk of mortality in anemic patients taking
clopidogrel was higher (HR 2.38 [95% CI 1.01–5.67]; p = .049).
Conclusions
In this registry involving ACS patients, anemia had influence on clinical management
and antiplatelet therapy. Patients suffering from anemia had higher risk for major
bleeding and mortality. In particular, anemic patients treated with clopidogrel had
even more mortality events.
Keywords
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Article info
Publication history
Published online: December 19, 2018
Accepted:
December 17,
2018
Received in revised form:
November 13,
2018
Received:
May 28,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
