Anemia and inflammation have an additive value in risk stratification of patients undergoing coronary interventions

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.