Anemia in patients with acute coronary syndromes treated with prasugrel or ticagrelor: Insights from the RENAMI registry
Anemia in patients with acute coronary syndromes treated with prasugrel or ticagrelor: Insights from the RENAMI registry
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DOI：
10.1016/j.thromres.2018.05.024
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发表时间：
2018-07-01
影响因子：
7.5
通讯作者：
Cequier, Angel
中科院分区：
文献类型：
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作者：
Guerrero, Carme;Garay, Alberto;Cequier, Angel
简介：推荐替格瑞洛和普拉格雷作为急性冠状动脉综合征（ACS）患者的一线治疗。然而，贫血患者在常规临床实践中通常使用氯吡格雷治疗。 RENAMI 登记（急性心肌梗死患者新抗血小板治疗登记）包括出院时接受普拉格雷或替格瑞洛治疗的 ACS 患者。本研究的目的是根据贫血状况分析贫血的患病率以及这些患者的特征和结局。方法：纳入来自 11 个中心的连续 ACS 患者。所有患者均接受经皮冠状动脉介入治疗（PCI）。贫血定义为男性血红蛋白< 130 g/L，女性血红蛋白< 120 g/L。一年后评估缺血和出血事件的发生率以及全因死亡率。结果：在 4424 名患者中，405 名 (9.2%) 符合贫血标准。贫血患者年龄明显较大，外周动脉疾病、既往出血和肾功能不全的患病率较高，出血风险较高（PRECISE-DAPT评分=25：37.3% vs 18.8%，p < 0.001）。贫血患者中BARC 3/5出血的发生率稍高（5.4% vs 1.5%，p=0.001）。根据贫血状况，支架内血栓或再梗死的发生率没有显着差异。贫血与死亡率独立相关（HR 1.73；95% CI 1.03-2.91，p=0.022）。结论：接受替格瑞洛或普拉格雷治疗的患者中有相当一部分符合贫血标准。贫血是死亡率的独立预测因素。尽管贫血患者的出血风险较高，但其出血率仍处于可接受的范围内。
Introduction: Ticagrelor and prasugrel are recommended as first line therapy in patients with acute coronary syndromes (ACS). However, patients with anemia are commonly treated with clopidogrel in routine clinical practice. The RENAMI registry (REgistry of New Antiplatelet therapy in patients with acute Myocardial Infarction) included ACS patients treated with prasugrel or ticagrelor at hospital discharge. The aim of this study was to analyze the prevalence of anemia and characteristics and outcomes of these patients according to anemia status.Methods: Consecutive patients with ACS from 11 centers were included. All patients underwent percutaneous coronary intervention (PCI). Anemia was defined as hemoglobin< 130 g/L in men and< 120 g/L in women. The incidence of ischemic and bleeding events and all-cause mortality were assessed at one year.Results: From 4424 patients included, 405 (9.2%) fulfilled criteria of anemia. Patients with anemia were significantly older, had a higher prevalence of peripheral artery disease, previous bleeding and renal disfunction and higher bleeding risk (PRECISE-DAPT score=25: 37.3% vs 18.8%, p < 0.001) The incidence of BARC 3/5 bleeding was moderately higher in patients with anemia (5.4% vs 1.5%, p=0.001). The incidence of stent thrombosis or reinfarction was not significantly different according to anemia status. Anemia was independently associated with mortality (HR 1.73; 95% CI 1.03-2.91, p=0.022).Conclusions: A not negligible proportion of patients treated with ticagrelor or prasugrel met criteria for anemia. Anemia was an independent predictor of mortality. Despite their higher bleeding risk profile, patients with anemia had an acceptable rate of bleeding.