Fukuoka Ryoma, Yamaji Kyohei, Kohsaka Shun, Ishii Hideki, Mori Yuichiro, Numasawa Yohei, Watanabe Tetsu, Nakayama Takashi, Sugimura Koichiro, Fujimoto Yoshihide, Ieda Masaki, Kawamura Akio, Amano Tetsuya, Kozuma Ken
Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
Department of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, Japan.
Open Heart. 2025 Jun 3;12(1):e003146. doi: 10.1136/openhrt-2024-003146.
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.
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.
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).
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.
贫血和慢性肾脏病（CKD）均为经皮冠状动脉介入治疗（PCI）后出血事件的既定危险因素。这些情况常同时存在；然而，以往对这些因素单独进行的评估可能导致对其对临床结局影响的低估。
我们分析了日本全国PCI注册中心2017年至2020年间接受PCI的77482例患者的数据。根据术前贫血（血红蛋白：男性<13g/dL；女性<12g/dL）和CKD（估计肾小球滤过率<60mL/min/1.73m²）状态，将患者分为“既无贫血也无CKD”组（n = 36629；47.3%）、“单纯CKD”组（n = 17120；22.1%）、“单纯贫血”组（n = 10136；13.1%）和“贫血合并CKD”组（n = 13597；17.5%）。研究终点包括出血（致命或非致命大出血）和缺血性（心血管死亡、非致命急性冠状动脉综合征或非致命缺血性卒中）事件。
“贫血合并CKD”组出血和缺血性事件的1年发生率最高，“既无贫血也无CKD”组最低。调整后，与“既无贫血也无CKD”组相比，“单纯贫血”（HR 1.52；95%CI 1.29至1.79；p<0.001）和“贫血合并CKD”（HR 1.39；95%CI 1.18至1.63；p<0.001），而非“单纯CKD”（HR 1.00；95%CI 0.85至1.17；p = 0.97），与出血事件的高风险显著相关。与“既无贫血也无CKD”组相比，所有三组的缺血性风险均更高（“单纯CKD”：HR 1.29；95%CI 1.16至1.45；p<0.001，“单纯贫血”：HR 1.40；95%CI 1.22至1.60；p<0.001，“贫血合并CKD”：HR 1.61；95%CI 1.43至1.81；p<0.001）。
无论CKD状态如何，贫血都会增加出血风险，而“单纯CKD”则不会。此外，贫血和/或CKD患者发生缺血性事件的风险更高。临床医生应对接受PCI的患者常规进行按贫血和CKD分层的初始风险评估。
