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Prognostic implications of anemia with or without chronic kidney disease in patients undergoing elective percutaneous
Yuichiro Kitai1, Neiko Ozasa, Takeshi Morimoto
1Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan.
Insights
Even mild anemia significantly worsens outcomes after elective percutaneous coronary intervention (PCI). Patients with anemia and chronic kidney disease (CKD) face additively increased risks for major adverse cardiac events (MACE).
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- Prognostic implications of anemia in patients undergoing elective percutaneous coronary intervention (PCI) are not well understood.
- Limited data exists on anemia's impact in PCI patients with coexisting chronic kidney disease (CKD).
Purpose of the Study:
- To investigate the association between anemia and 3-year major adverse cardiac events (MACE) in patients undergoing elective PCI.
- To evaluate the combined effect of anemia and CKD on MACE risk in this population.
Main Methods:
- Analysis of 7299 patients from the CREDO-Kyoto registry cohort-2 who underwent elective PCI.
- Primary outcome defined as 3-year MACE (all-cause death, heart failure hospitalization, myocardial infarction).
- Subgroup analyses conducted for patients with and without CKD.
Main Results:
- 20.0% had mild anemia and 10.1% had moderate-to-severe anemia.
- Mild and moderate-to-severe anemia were associated with significantly higher MACE incidence (7.9%, 20.1%, 34.2%) compared to no anemia.
- Adjusted hazard ratios for MACE were 1.77 for mild anemia and 2.53 for moderate-to-severe anemia.
- Anemia increased MACE risk in both CKD and non-CKD patients, with an additive risk observed when both conditions were present.
Conclusions:
- Mild anemia is linked to significantly worse 3-year clinical outcomes post-elective PCI.
- Coexisting CKD additively increases the risk of MACE in patients with anemia undergoing elective PCI.
Background:
Little is known about the prognostic implications of anemia in patients undergoing elective percutaneous coronary intervention (PCI), especially when they have coexisting chronic kidney disease (CKD).
Methods:
We identified 7299 patients who underwent elective PCI from the CREDO-Kyoto registry cohort-2. The primary outcome was 3-year major adverse cardiac events (MACE); composite of all cause death, heart failure hospitalization, and myocardial infarction.
Results:
In total, 1466 patients (20.0%) had mild anemia (hemoglobin=11.0-11.9 g/dL for women and 11.0-12.9 g/dL for men), and 740 patients (10.1%) had moderate-to-severe anemia (hemoglobin<11.0 g/dL both for women and for men). Compared to the no-anemia group, cumulative incidence of MACE was significantly higher in the mild and moderate-to-severe anemia groups (7.9%, 20.1%, and 34.2%, respectively). The adjusted hazard ratios of mild and moderate-to-severe anemia versus no-anemia for MACE were 1.77 (95% confidence interval: 1.47-2.15) and 2.53 (95% confidence interval: 2.03-3.14), respectively. In a subgroup analysis, significantly higher risk for MACE was consistently observed with mild and moderate-to-severe anemia both in patients with and without CKD. The risk for MACE showed an accretive increment with exacerbation in either the renal function or anemia (interaction p<0.001).
Conclusions:
Even mild anemia was associated with significantly worse 3-year clinical outcomes in patients who underwent elective PCI. Coexisting CKD additively increased the risk for MACE in these patients.
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