Prevalence and prognostic impact of anaemia in patients undergoing percutaneous coronary intervention and receiving cangrelor: a subanalysis of the icarus registry

Abstract Aims To assess the clinical characteristics and compare in-hospital outcomes of patients with and without anaemia receiving cangrelor in the peri-percutaneous coronary intervention (PCI) phase. Methods Consecutive patients treated with cangrelor in 7 Italian institutions were retrospectively enrolled in the ICARUS (“Intravenous CAngrelor in high-bleeding Risk patients Undergoing percutaneouS coronary intervention”, NCT05505591) registry. According to the World Health Organization, anaemia was defined as haemoglobin (Hb) levels < 13 g/dL in men and < 12 g/dL in women; severe anaemia as an Hb value < 11 g/dL irrespective of sex. The primary endpoint was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis and Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, at 48 hours. Secondary endpoints were assessed at 48 hours. Major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction, stroke and definite or probable stent thrombosis were also evaluated at discharge. Results Out of 551 patients undergoing PCI with cangrelor between January 2019 and August 2022, 125 (23%) were anaemic. Mean age was 74±10 vs. 65±11 years in anaemic vs. non-anaemic patients (p<0.001). Baseline haemoglobin significantly differed between the two arms (12±1 vs. 15±1.2 mg/dl, p<0.001); severe anaemia occurred in the 24% of anaemic patients. Atrial fibrillation (20% vs. 6%, p<0.001) and chronic kidney disease (31% vs. 9%, p<0.001) were more frequent among anaemic individuals, in whom clopidogrel was more frequently administered after PCI (42% vs. 25%, p<0.001). At 48 hours, anaemic patients had higher rates of NACE (14% vs. 7%, p=0.019) and BARC 2, 3 or 5 bleeding (12% vs. 5%, p=0.013), whereas the rates of other 48-hour endpoints did not differ. At multivariable analysis, severe anaemia (odds ratio [OR] 1.12, 95% CI 1.02-1.24, p=0.015), acute coronary syndrome at presentation (OR 1.06, 95% CI 1.01-1.12, p=0.013), femoral access (OR 1.12, 95% CI 1.04-1.20, p=0.001) and cardiogenic shock (OR 1.27, 95% CI 1.13-1.44, p<0.001) independently predicted the occurrence of NACE. Complete in-hospital follow-up was available in 549 (99.6%) of patients, with MACE rates being not significantly different between anaemic and non-anaemic patients (2.4% vs. 2.8%, p= 0.593). Conclusions Anaemia is a distinctive risk feature among patients receiving intravenous cangrelor in the peri-PCI phase. Anaemic patients experience higher incidence of adverse events at 48 hours, with severe anaemia being an independent predictor of NACE.