The impact of concomitant anemic syndrome on the clinical course of coronary artery disease

Authors

DOI:

https://doi.org/10.14739/2310-1237.2021.3.237926

Keywords:

coronary artery disease, anemia, cardiovascular events, heart failure

Abstract

The presence of comorbid pathology negatively affects the prognosis of patients with coronary artery disease (CAD). Today it is important to clarify the features of CAD on the background of concomitant anemia and identify the main risk factors for complications to improve the tactics of this category of patients.

The aim. To investigate the influence of concomitant anemic syndrome on the clinical course of coronary artery disease, frequency and features of the main cardiovascular events.

Materials and methods. The study involved 91 patients with coronary artery disease (42 men and 49 women, age – 70 (49; 93)). All patients were divided into 2 groups: the main group (n = 46) consisted of patients with coronary artery disease with iron-deficiency anemia, the comparison group (n = 45) – patients with coronary artery disease without iron-deficiency anemia. The study of the main cardiovascular events took into account re-hospitalization due to arrhythmic disorders, progression of heart failure (HF), CAD destabilization within the observed period (1 year), as well as death from cardiovascular causes. The data analysis was performed using Statistica 13.0.

Results. During the year, 42 non-fatal cardiovascular events were noted in patients of both groups, however in the main group their total number was 30 (67 %) versus 12 (27 %) in the comparison group (χ2 = 13.603; P < 0.05). The presence of concomitant anemia in CAD patients significantly increased the relative risk of re-hospitalizations (RR = 1.9; 95 % CI 1.230–3.112; P < 0.05). Among the reasons for hospitalization in the main group, HF decompensation prevailed – 17 (57 %) patients, unstable angina – 7 (23 %), arrhythmic disorders – 6 (20 %); in the comparison group, among the reasons for re-hospitalization, 7 (57 %) had HF decompensation, 3 (25 %) had unstable angina, and 2 (17 %) cases had arrhythmic disorders. In total, 9 (19.5 %) deaths were recorded in the main group, while in the comparison group 1 (2.2 %) death was recorded during the year (χ2 = 6.995; P < 0.05). The presence of concomitant anemia in patients with CAD increases the risk of fatal outcome by 8.8 times (RR = 8.8; 95 % CI 1.162–66.685; P < 0.05). The presence of moderate anemia in patients with CAD significantly increases the incidence of combined critical events by 39 % during the year of follow-up compared with mild anemia (χ2 = 12.843; P < 0.05).

Conclusions. The presence of concomitant anemia is associated with a worsened prognosis for patients having coronary artery disease due to an increased risk of non-fatal cardiovascular events that require re-hospitalization during the year of observation, and an increased incidence of death. Increasing severity of anemia is associated with an increase in the frequency of the combined critical event during 1 year of follow-up.

Author Biographies

M. O. Konovalova, Zaporizhzhia State Medical University, Ukraine

PhD Student of the Department of General Practice – Family Medicine and Internal Diseases

N. S. Mykhailovska, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Practice – Family Medicine and Internal Diseases

References

Mykhailovska, N. S., Stetsiuk, I. O., Kulinych, T. O., & Lisova, O. O. (2019). Klinichna efektyvnist zastosuvannia L-arhininu u khvorykh na ishemichnu khvorobu sertsia ta metabolichnyi syndrom [Clinical Effectiveness of L-arginin Supplementation in Patients with Coronary Artery Disease and Metabolic Syndrome]. Semeinaya meditsina, (2), 59-65. [in Ukrainian]. https://doi.org/10.30841/2307-5112.2.2019.175134

Mykhailovska, N. S., Stetsiuk, I. O., Kulynych, T. O., Gorbachova, S. V., & Zhulkevych, I. V. (2020). The interrelationship of bone and cardiovascular remodeling biomarkers and clinical peculiarities of coronary artery disease in postmenopausal women. Reumatologia, 58(3), 142-149. https://doi.org/10.5114/reum.2020.96687

Gorbachova, V. V., Lіashenko, A. V., Gavrilenko, T. I., Mkhitaryan, L. S., & Voronkov, L. G. (2018). Kliniko-instrumentalna kharakterystyka ta klinichnyi prohnoz u patsiientiv z khronichnoiu sertsevoiu nedostatnistiu i znyzhenoiu fraktsiieiu vykydu livoho shlunochka zalezhno vid naiavnosti ta kharakteru zalizodefitsytnoho stanu [Clinical and instrumental characteristics, clinical prognosis in patients with chronic heart failure and reduced left ventricular ejection fraction, depending on the presence and nature of the iron deficiency state]. Ukrainskyi kardiolohichnyi zhurnal, (5), 29-38. [in Ukrainian]. http://doi.org/10.31928/1608-635X-2018.5.2938

Dolynna, O. V. (2016). Patohenez ta shliakhy korektsii anemichnoho syndromu u patsiientiv z khronichnoiu sertsevoiu nedostatnistiu [Pathogenesis and ways of correcting anemia syndrome in patients with chronic heart failure]. Semeinaya meditsina, (1), 58-62. [in Ukrainian].

Oslopov, V. N., Khazova, E. V., Khabibullina, R. T., Oslopova, D. V., Khanaphieva, A. L., Oslopova, Yu. V., Malkova, M. I., & Delian, A. M. (2019). Koronarnye, no ne ishemicheskie maski anemii [Coronary, but not ischemic anemia masks]. Vestnik sovremennoi klinicheskoi meditsiny, 12(5), 104-118. [in Russian]. https://doi.org/10.20969/VSKM.2019.12(5).104-118

Gorohovskaya, G. N., Martynov, A. I., Yun, V. L., & Petina, M. M. (2020). Sovremennyi vzglyad terapevta na problemu zhelezodefitsitnoi anemii u patsientov s serdechno-sosudistoi patologiei [The modern view of general practitioner on the problem of iron deficiency anemia in patients with cardiovascular pathology]. Meditsinskiy sovet = Medical Council, (14), 70-78. [in Russian]. https://doi.org/10.21518/2079-701X-2020-14-70-78

Sidaruk, S. P., Petrova, E. B., & Mitkovskaya, N. P. (2017). Anemiya pri serdechno-sosudistykh zabolevaniyakh [Anemia in Cardiovascular Diseases]. Neotlozhnaya kardiologiya I kardioovaskulyarnye riski, 1(1), 38-45. [in Russian].

Vatutin, N. T., Taradin, G. G., & Venzheha, V. V. (2019). Anemiya i zhelezodefitsit u bol'nykh s khronicheskoi serdechnoi nedostatochnost'yu [Anaemia and iron deficiency in chronic heart failure patients]. Kardiologiia, 59(4), 4-20. [in Russian]. https://doi.org/10.18087/cardio.2638

Sayar, N. (2017). Stable Angina Pectoris. Marmara University, Department of Cardiology (pp. 1-9). http://www.smgebooks.com/Angina-Pectoris/chapters/AP-17-02.pdf

Katerenchuk, O. I. (2017). Typovi hematolohichni syndromy v kardiolohii: anemiia u patsiientiv z ishemichnoiu sertsevoiu nedostatnistiu [Typical hematological syndromes in cardiology: anemia in patients with ischemic heart failure]. Visnyk problem biolohii i medytsyny, 2, 137-139. [in Ukrainian].

Kuskaeva, A. V., Nikulina, S. Yu, Chernova, A. A., & Aksyutina, N. V. (2016). Geneticheskie prediktory fibrillyatsiii predserdii [Genetic predictors of atrial fibrillation]. Ratsional'naya Farmakoterapiya v Kardiologii, 12(3), 331-336. [in Russian]. https://doi.org/10.20996/1819-6446-2016-12-3-331-336

Migone de Amicis, M., Chivite, D., Corbella, X., Cappellini, M. D., & Formiga, F. (2017). Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure. Internal and emergency medicine, 12(6), 749-756. https://doi.org/10.1007/s11739-017-1637-5

Kim-Mitsuyama, S., Soejima, H., Yasuda, O., Node, K., Jinnouchi, H., Yamamoto, E., Sekigami, T., Ogawa, H., & Matsui, K. (2019). Anemia is an independent risk factor for cardiovascular and renal events in hypertensive outpatients with well-controlled blood pressure: a subgroup analysis of the ATTEMPT-CVD randomized trial. Hypertension research, 42(6), 883-891. https://doi.org/10.1038/s41440-019-0210-1

Paolillo, S., Scardovi, A. B., & Campodonico, J. (2020). Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation. European journal of preventive cardiology, 27(2_suppl), 27-34. https://doi.org/10.1177/2047487320960288

Cho, M. E., Hansen, J. L., Sauer, B. C., Cheung, A. K., Agarwal, A., & Greene, T. (2021). Heart Failure Hospitalization Risk associated with Iron Status in Veterans with CKD. Clinical journal of the American Society of Nephrology : CJASN, 16(4), 522-531. https://doi.org/10.2215/CJN.15360920

Lim, W. H., Choi, E. K., Han, K. D., Lee, S. R., Cha, M. J., & Oh, S. (2020). Impact of Hemoglobin Levels and Their Dynamic Changes on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study. Scientific reports, 10(1), 6762. https://doi.org/10.1038/s41598-020-63878-9

Kalra, P. R., Greenlaw, N., Ferrari, R., Ford, I., Tardif, J. C., Tendera, M., Reid, C. M., Danchin, N., Stepinska, J., Steg, P. G., Fox, K. M., & ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) Investigators (2017). Hemoglobin and Change in Hemoglobin Status Predict Mortality, Cardiovascular Events, and Bleeding in Stable Coronary Artery Disease. The American journal of medicine, 130(6), 720-730. https://doi.org/10.1016/j.amjmed.2017.01.002

Abebe, T. B., Gebreyohannes, E. A., Bhagavathula, A. S., Tefera, Y. G., & Abegaz, T. M. (2017). Anemia in severe heart failure patients: does it predict prognosis?. BMC cardiovascular disorders, 17(1), 248. https://doi.org/10.1186/s12872-017-0680-5

Davidsen, L., Kragholm, K. H., Aldahl, M., Polcwiartek, C., Torp-Pedersen, C., Soegaard, P., & Freeman, P. (2020). Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina. Open heart, 7(2), e001319. https://doi.org/10.1136/openhrt-2020-001319

Downloads

Published

2021-12-01

How to Cite

1.
Konovalova MO, Mykhailovska NS. The impact of concomitant anemic syndrome on the clinical course of coronary artery disease. Pathologia [Internet]. 2021Dec.1 [cited 2024Nov.9];18(3):263-8. Available from: http://pat.zsmu.edu.ua/article/view/237926

Issue

Section

Original research