The link between anemia and adverse outcomes in patients with acute coronary syndrome

ABSTRACT

Introduction: Anemia is one of the most frequent comorbidities in acute coronary syndrome (ACS) patients and is associated with a significant impact on clinical outcomes. This review summarizes the knowledge and updated management of anemia in the setting of ACS.

Areas covered: We provide a review on the prevalence, pathophysiology, prognosis, impact, and updated management of anemia.

Expert opinion: Patients with anemia represent a therapeutic challenge in the setting of acute coronary syndrome and require specific acute and chronic management. Despite the high prevalence of anemia and the large amount of data confirming its strong impact on short- and long-term outcomes, a commonly used and accurate definition in the context of patients undergoing percutaneous coronary intervention and stent implantation for ACS is still lacking. Furthermore, therapeutic options to address anemia remain limited. The combined use of risk scores to identify high-risk characteristics for adverse bleeding or thrombotic events may guide individualized treatment of anemic patients, for example, by selecting an antiplatelet regimen aimed at minimizing bleeding or thrombotic risk. The optimal strategy for blood transfusion is currently being evaluated by an ongoing randomized trial.

KEYWORDS:

• Anemia
• acute coronary syndrome
• red blood transfusion

Article highlights

• Anemia may be present in 10.5–46.4% of patients hospitalized for acute coronary syndrome, although significant heterogeneities are present in the definition of anemia across trials and registries.

• Anemia is a strong risk factor of adverse outcomes in patients with acute coronary syndromes

• Prevention of in-hospital bleeding and risk-stratification to avoid further bleeding events after discharge represent the foundation of clinical management of anemic patients

Declaration of interest

P Guedeney has received research grants from Federation Francaise de cardiologie and fond de dotation Action Coeur. R Mehran has received institutional research grant support from The Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, and AstraZeneca and consulting fees from AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals Inc., Merck & Co, Osprey Medical Inc, and Watermark Research Partners and serves on the advisory board of Abbott Laboratories, Boston Scientific Corporation, Covidien, Janssen Pharmaceuticals, The Medicines Company, and Sanofi-Aventis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.