Impact of anaemia on clinical outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry.
OBJECTIVE
Anaemia has an adverse impact on the outcome in the general patient population undergoing percutaneous coronary intervention (PCI). The aim of this study was to analyse the impact of anaemia on the 12-month clinical outcome of patients with atrial fibrillation (AF) undergoing PCI and therefore requiring intense antithrombotic treatment. We hypothesised that anaemia might be associated with a worse outcome and more bleeding in these anticoagulated patients.


METHODS
Data were collected from 17 secondary care centres in Europe.


METHODS
Consecutive patients with AF undergoing PCI were enrolled in the prospective, multicenter AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry. Altogether, 929 patients participated in the study. Preprocedural haemoglobin concentration was available for 861 (92.7%; 30% women). The only exclusion criteria were inability or unwillingness to give informed consent. Anaemia was defined as a haemoglobin concentration of <12 g/dL for women and <13 g/dL for men.


METHODS
The primary endpoint was occurrence of major adverse cardiac and cerebrovascular events (MACCE) or bleeding events.


RESULTS
258/861 (30%) patients had anaemia. Anaemic patients were older, more often had diabetes, higher CHA2DS2-VASc scores, prior history of heart failure, chronic renal impairment and acute coronary syndrome. Anaemic patients had more MACCE than non-anaemic (29.1% vs 19.4%, respectively, p=0.002), and minor bleeding events (7.0% vs 3.3%, respectively, p=0.028), with a trend towards more total bleeding events (25.2% vs 21.7%, respectively, p=0.059). No difference was observed in antithrombotic regimens at discharge. In multivariate analysis, anaemia was an independent predictor of all-cause mortality at 12-month follow-up (hazard ratio 1.62, 95% CI 1.05 to 2.51, p=0.029).


CONCLUSIONS
Anaemia was a frequent finding in patients with AF referred for PCI. Anaemic patients had a higher all-cause mortality, more thrombotic events and minor bleeding events. Anaemia seems to be an identification of patients at risk for cardiovascular events and death.


BACKGROUND
ClinicalTrials.gov number NCT00596570.
Hemostasis Laboratory, Finnish Red Cross Blood Service, Helsinki, Finland.
Marja
M
Puurunen
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Tuomas
T
Kiviniemi
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Wail
W
Nammas
Medical Faculty, Martin Luther University Halle-Wittenberg, Halle-Wittenberg, Germany.
Axel
A
Schlitt
Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
Andrea
A
Rubboli
Department of Cardiology, Central Finland Central Hospital, Jyväskylä, Finland.
Kai
K
Nyman
Heart Center, Satakunta Central Hospital, Pori, Finland.
Pasi
P
Karjalainen
Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Paulus
P
Kirchhof
Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
Gregory Y H
GY
Lip
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Juhani K E
JK
Airaksinen
D000368:Aged; D000740:Anemia / Q000150:complications*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
CARDIOLOGY; HAEMATOLOGY