RT Journal Article
SR Electronic
T1 Impact of anaemia on clinical outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention: insights from the AFCAS registry
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e004700
DO 10.1136/bmjopen-2013-004700
VO 4
IS 5
A1 Puurunen, Marja
A1 Kiviniemi, Tuomas
A1 Nammas, Wail
A1 Schlitt, Axel
A1 Rubboli, Andrea
A1 Nyman, Kai
A1 Karjalainen, Pasi
A1 Kirchhof, Paulus
A1 Lip, Gregory Y H
A1 Airaksinen, Juhani K E
YR 2014
UL http://bmjopen.bmj.com/content/4/5/e004700.abstract
AB Objectives 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. Setting Data were collected from 17 secondary care centres in Europe. Participants 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. Outcome measures 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. Trial registration ClinicalTrials.gov number NCT00596570.