Association Between Anemia and Prognosis in Patients With Acute Coronary Syndrome and Atrial Fibrillation

Patients with acute coronary syndromes (ACS) and atrial fibrillation (AF) have more complex conditions, making risk stratification crucial. The added discriminatory power of including anemia in the CHA₂DS₂-VASc ([congestive heart failure, hypertension, age [>65 = 1 point, >75 = 2 points], diabetes, previous stroke/systemic embolism/transient ischemic attack [2 points], vascular disease, age 65-74 years, and sex category]) score for poor prognosis in this population remains unclear. This study investigates the impact of anemia on 1166 patients with ACS and AF from 2017 to 2019. Multivariate Cox regression analysis showed anemia significantly increased the risk of all-cause mortality (Hazard ratio [HR] = 1.935, 95% CI: 1.106-3.384, <i>P</i> = .021) and major adverse cardiovascular events (MACE; HR = 1.857, 95% CI: 1.171-2.945, <i>P</i> = .009), but not thromboembolic events (HR = 0.651, 95% CI: 0.210-2.022, <i>P</i> = .458). Receiver operating characteristic (ROC) curves showed that hemoglobin's area under the curve (AUC) for mortality and MACE was 0.722 and 0.710, respectively, improving to 0.770 and 0.772 when combined with the CHA₂DS₂-VASc score. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) metrics showed significant improvement in predicting mortality (NRI = 0.258, <i>P</i> = .004; IDI = 0.037, <i>P</i> < .001) and MACE (NRI = 0.232, <i>P</i> = .002; IDI = 0.026, <i>P</i> = .004). Adding hemoglobin to the CHA₂DS₂-VASc score enhances its predictive performance.