Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry
Background Anaemia and chronic kidney disease (CKD) are both established risk factors for bleeding events after percutaneous coronary intervention (PCI). These conditions often coexist; however, previous assessments of these factors individually may have led to an underestimation of their impact on...
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BMJ Publishing Group
2025-06-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003146.full |
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| author | Yohei Numasawa Shun Kohsaka Ken Kozuma Kyohei Yamaji Hideki Ishii Tetsuya Amano Akio Kawamura Ryoma Fukuoka Yoshihide Fujimoto Takashi Nakayama Yuichiro Mori Masaki Ieda Tetsu Watanabe Koichiro Sugimura |
| author_facet | Yohei Numasawa Shun Kohsaka Ken Kozuma Kyohei Yamaji Hideki Ishii Tetsuya Amano Akio Kawamura Ryoma Fukuoka Yoshihide Fujimoto Takashi Nakayama Yuichiro Mori Masaki Ieda Tetsu Watanabe Koichiro Sugimura |
| author_sort | Yohei Numasawa |
| collection | DOAJ |
| description | Background Anaemia and chronic kidney disease (CKD) are both established risk factors for bleeding events after percutaneous coronary intervention (PCI). These conditions often coexist; however, previous assessments of these factors individually may have led to an underestimation of their impact on clinical outcomes.Methods We analysed the data of 77 482 patients who underwent PCI between 2017 and 2020 in the Japanese nationwide PCI registry. Based on preprocedural anaemia (haemoglobin: <13 g/dL in men; <12 g/dL in women) and CKD (estimated glomerular filtration rate, <60 mL/min/1.73 m²) statuses, the patients were categorised into ‘neither anaemia nor CKD’ (n=36 629; 47.3%), ‘CKD alone’ (n=17 120; 22.1%), ‘anaemia alone’ (n=10 136; 13.1%) and ‘both anaemia and CKD’ (n=13 597; 17.5%) groups. The study endpoints included bleeding (fatal or non-fatal major bleeding) and ischaemic (cardiovascular death, non-fatal acute coronary syndrome or non-fatal ischaemic stroke) events.Results The 1-year incidence of bleeding and ischaemic events was highest in the ‘both anaemia and CKD’ group and lowest in the ‘neither anaemia nor CKD’ group. After adjustment, ‘anaemia alone’ (HR 1.52; 95% CI 1.29 to 1.79; p<0.001) and ‘both anaemia and CKD’ (HR 1.39; 95% CI 1.18 to 1.63; p<0.001), but not ‘CKD alone’ (HR 1.00; 95% CI 0.85 to 1.17; p=0.97), were significantly associated with high risks of bleeding events compared with ‘neither anaemia nor CKD’. All three groups had higher ischaemic risk compared with ‘neither anaemia nor CKD’ (‘CKD alone’: HR 1.29; 95% CI 1.16 to 1.45; p<0.001, ‘anaemia alone’: HR 1.40; 95% CI 1.22 to 1.60; p<0.001, ‘both anaemia and CKD’: HR 1.61; 95% CI 1.43 to 1.81; p<0.001).Conclusions Anaemia increased bleeding risk regardless of CKD status, whereas ‘CKD alone’ did not. In addition, patients with anaemia and/or CKD were at a higher risk of ischaemic events. Clinicians should routinely perform initial risk assessments stratified by anaemia and CKD for patients undergoing PCI. |
| format | Article |
| id | doaj-art-e02ca0c7c7c045c9864caf045b49535a |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
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| series | Open Heart |
| spelling | doaj-art-e02ca0c7c7c045c9864caf045b49535a2025-08-20T02:02:01ZengBMJ Publishing GroupOpen Heart2053-36242025-06-0112110.1136/openhrt-2024-003146Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registryYohei Numasawa0Shun Kohsaka1Ken Kozuma2Kyohei Yamaji3Hideki Ishii4Tetsuya Amano5Akio Kawamura6Ryoma Fukuoka7Yoshihide Fujimoto8Takashi Nakayama9Yuichiro Mori10Masaki Ieda11Tetsu Watanabe12Koichiro Sugimura13Department of Cardiology, Keio University School of Medicine, Tokyo, JapanDepartment of Cardiology, Keio University School of Medicine, Tokyo, JapanDepartment of Cardiology, Teikyo University School of Medicine, Tokyo, JapanDepartment of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiology, Gunma University Graduate School of Medicine, Gunma, JapanDepartment of Cardiology, Aichi Medical University, Aichi, JapanDepartment of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, JapanDepartment of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, JapanDepartment of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, JapanDepartment of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, JapanDepartment of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, JapanDepartment of Cardiology, Keio University School of Medicine, Tokyo, JapanDepartment of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, JapanDepartment of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, JapanBackground Anaemia and chronic kidney disease (CKD) are both established risk factors for bleeding events after percutaneous coronary intervention (PCI). These conditions often coexist; however, previous assessments of these factors individually may have led to an underestimation of their impact on clinical outcomes.Methods We analysed the data of 77 482 patients who underwent PCI between 2017 and 2020 in the Japanese nationwide PCI registry. Based on preprocedural anaemia (haemoglobin: <13 g/dL in men; <12 g/dL in women) and CKD (estimated glomerular filtration rate, <60 mL/min/1.73 m²) statuses, the patients were categorised into ‘neither anaemia nor CKD’ (n=36 629; 47.3%), ‘CKD alone’ (n=17 120; 22.1%), ‘anaemia alone’ (n=10 136; 13.1%) and ‘both anaemia and CKD’ (n=13 597; 17.5%) groups. The study endpoints included bleeding (fatal or non-fatal major bleeding) and ischaemic (cardiovascular death, non-fatal acute coronary syndrome or non-fatal ischaemic stroke) events.Results The 1-year incidence of bleeding and ischaemic events was highest in the ‘both anaemia and CKD’ group and lowest in the ‘neither anaemia nor CKD’ group. After adjustment, ‘anaemia alone’ (HR 1.52; 95% CI 1.29 to 1.79; p<0.001) and ‘both anaemia and CKD’ (HR 1.39; 95% CI 1.18 to 1.63; p<0.001), but not ‘CKD alone’ (HR 1.00; 95% CI 0.85 to 1.17; p=0.97), were significantly associated with high risks of bleeding events compared with ‘neither anaemia nor CKD’. All three groups had higher ischaemic risk compared with ‘neither anaemia nor CKD’ (‘CKD alone’: HR 1.29; 95% CI 1.16 to 1.45; p<0.001, ‘anaemia alone’: HR 1.40; 95% CI 1.22 to 1.60; p<0.001, ‘both anaemia and CKD’: HR 1.61; 95% CI 1.43 to 1.81; p<0.001).Conclusions Anaemia increased bleeding risk regardless of CKD status, whereas ‘CKD alone’ did not. In addition, patients with anaemia and/or CKD were at a higher risk of ischaemic events. Clinicians should routinely perform initial risk assessments stratified by anaemia and CKD for patients undergoing PCI.https://openheart.bmj.com/content/12/1/e003146.full |
| spellingShingle | Yohei Numasawa Shun Kohsaka Ken Kozuma Kyohei Yamaji Hideki Ishii Tetsuya Amano Akio Kawamura Ryoma Fukuoka Yoshihide Fujimoto Takashi Nakayama Yuichiro Mori Masaki Ieda Tetsu Watanabe Koichiro Sugimura Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry Open Heart |
| title | Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry |
| title_full | Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry |
| title_fullStr | Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry |
| title_full_unstemmed | Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry |
| title_short | Dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes: insights from the Japanese nationwide registry |
| title_sort | dual impact of anaemia and chronic kidney disease on postpercutaneous coronary intervention outcomes insights from the japanese nationwide registry |
| url | https://openheart.bmj.com/content/12/1/e003146.full |
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