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Published on: January 28, 2020
Anemia and inflammation have an additive value in risk stratification of patients undergoing coronary interventions
Arie Steinvil1, Ori Rogowski, Shmuel Banai
1aDepartment of Cardiology bDepartments of Medicine 'D' and 'E', the Tel-Aviv Sourasky Medical Center cSackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel *Arie Steinvil and Ori Rogowski should be considered as first authors.
Insights
Anemia and inflammation independently and additively increase major adverse cardiovascular events (MACE) in myocardial infarction (MI) patients. The combined presence of anemia and inflammation significantly elevates MACE risk in angina pectoris patients.
Area of Science:
- Cardiology
- Internal Medicine
- Biomarkers
Background:
- Anemia and inflammation are linked to poor outcomes in ischemic heart disease.
- Understanding their combined impact is crucial for patient management.
Purpose of the Study:
- To investigate the additive effects of anemia and inflammation on outcomes in patients undergoing percutaneous coronary intervention.
- To analyze the association of anemia and C-reactive protein (CRP) with major adverse cardiovascular events (MACE).
Main Methods:
- Cox regression models were used to analyze data from 1976 patients (2006-2011).
- Hemoglobin and CRP levels were assessed in patients with myocardial infarction (MI) and angina pectoris.
- MACE included all-cause mortality, MI, and stroke.
Main Results:
- In MI patients, anemia or elevated CRP increased MACE risk; both together significantly amplified this risk (HR 3.4, P < 0.01).
- In angina pectoris patients, MACE risk was elevated only when both anemia and elevated CRP were present (HR 2.9, P < 0.01).
Conclusions:
- Anemia and inflammation are independently and additively associated with MACE in MI patients.
- The combined presence of anemia and inflammation is a significant predictor of MACE in angina pectoris patients.
Aims:
Anemia and inflammation are both associated with unfavorable outcomes in patients with ischemic heart disease and might be pathophysiologically linked. We aimed to analyze the additive value of anemia and inflammation on the outcomes of patients undergoing percutaneous coronary intervention.
Methods:
Cox regression models were fitted for hemoglobin and C-reactive protein (CRP) cut-offs and performed separately for myocardial infarction (MI) and angina pectoris patients undergoing catheterization at a tertiary hospital between 2006 and 2011. Major adverse cardiovascular events (MACEs) were defined as all-cause mortality, MI and stroke.
Results:
Included were 1976 patients (825 with angina pectoris and 1151 with MI). The median follow-up in the MI and the angina pectoris groups was 14 and 13 months, respectively (maximal follow-up of 4 years). In the MI group, the risk of MACE during follow-up was increased with the presence of either anemia (hazard ratio 2.1, P = 0.07) or of elevated CRP (hazard ratio 1.9, P = 0.04), whereas the presence of both increased the risk even further (hazard ratio 3.4, P < 0.01). In the angina pectoris group, the risk of MACE was increased only in patients who had both anemia and elevated CRP (hazard ratio 2.9, P < 0.01).
Conclusion:
Inflammation and anemia are independently and additively associated with MACE in MI patients.
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