Anemia in Patients with Severe Aortic Stenosis
Authors: Nagao Kazuya , Taniguchi Tomohiko , Morimoto Takeshi , Shiomi Hiroki , Ando Kenji , Kanamori Norio , Murata Koichiro , Kitai Takeshi , Kawase Yuichi , Izumi Chisato , Miyake Makoto , Mitsuoka Hirokazu , Kato Masashi , Hirano Yutaka , Matsuda Shintaro , Inada Tsukasa , Murakami Tomoyuki , Takeuchi Yasuyo , Yamane Keiichiro , Toyofuku Mamoru , Ishii Mitsuru , Minamino-Muta Eri , Kato Takao , Inoko Moriaki , Ikeda Tomoyuki , Komasa Akihiro , Ishii Katsuhisa , Hotta Kozo , Higashitani Nobuya , Kato Yoshihiro , Inuzuka Yasutaka , Maeda Chiyo , Jinnai Toshikazu , Morikami Yuko , Saito Naritatsu , Minatoya Kenji , Kimura Takeshi ,   CURRENT AS Registry Investigators, Takahashi Naoki , Fukuchi Kohei , Imai Masao , Tazaki Junichi , Toyota Toshiaki , Higami Hirooki , Kawaji Tetsuma , Shirai Shinichi , Kourai Kengo , Arita Takeshi , Miura Shiro , Yamaji Kyohei , Onodera Tomoya , Furukawa Yutaka , Kim Kitae , Kadota Kazushige , Iwasaki Keiichiro , Miyawaki Hiroshi , Misao Ayumi , Kuwayama Akimune , Ohya Masanobu , Shimada Takenobu , Amano Hidewo , Nakagawa Yoshihisa , Amano Masashi , Takahashi Yusuke , Yoshikawa Yusuke , Nishimura Shunsuke , Kuroda Maiko , Shirotani Manabu , Miki Shinji , Mizoguchi Tetsu , Yokomatsu Takafumi , Kushiyama Akihiro , Yaku Hidenori , Watanabe Toshimitsu , Miyazaki Shunichi , Takeda Teruki , Sakaguchi Tomoko , Maeda Keiko , Yamaji Masayuki , Motoyoshi Maenaka , Tadano Yutaka , Sakamoto Hiroki , Motooka Makoto , Nishikawa Ryusuke , Eizawa Hiroshi , Kawato Mitsunori , Kinoshita Minako , Aida Kenji , Tamura Takashi , Takahashi Kousuke , Ko Euihong , Akao Masaharu , Masunaga Nobutoyo , Ogawa Hisashi , Iguchi Moritake , Unoki Takashi , Takabayashi Kensuke , Hamatani Yasuhiro , Yamashita Yugo , Himura Yoshihiro , Sato Yukihito , Tsuji Shuhei , Konishi Takashi , Sogabe Kouji , Tachiiri Michiya , Matsumura Yukiko , Ota Chihiro , Kouchi Ichiro , Ikeguchi Shigeru , Nishio Soji , Seki Jyunya , Shinoda Eiji , Yamada Miho , Kawamoto Akira , Kitaguchi Shoji , Sakata Ryuzo , Matsuda Mitsuo , Sugioka Sachiko , Hiraoka Yuji , Hanyu Michiya , Yamazaki Fumio , Koyama Tadaaki , Komiya Tatsuhiko , Yamanaka Kazuo , Nishiwaki Noboru , Nakajima Hiroyuki , Ohnaka Motoaki , Osada Hiroaki , Meshii Katsuaki , Saga Toshihiko , Onoe Masahiko , Nakayama Shogo , Sakaguchi Genichi , Iwakura Atsushi , Shiraga Kotaro , Ueyama Koji , Fujiwara Keiichi , Fukumoto Atsushi , Miwa Senri , Nishizawa Junichiro , Kitano Mitsuru 
Published: February 2019

Prognostic impact of anemia complicating severe aortic stenosis (AS) remains unclear. We assessed the impact of anemia on cardiovascular and bleeding outcomes in 3403 patients enrolled in the CURRENT AS registry. 835 patients (25%) had mild (hemoglobin 11.0–12.9 g/dl for men/11.0–11.9 g/dl for women) and 1282 patients (38%) had moderate/severe anemia (Hb ≤ 10.9 g/dl) at diagnosis of severe AS. Mild and moderate/severe anemia were associated with significantly increased risks relative to no anemia (hemoglobin ≥13.0 g/dl for men/≥12.0 g/dl for women) for the primary outcome measure (aortic valve-related death or heart failure hospitalization) in the entire population [hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.07–1.57 and HR: 1.56; 95%CI: 1.31–1.87, respectively] and in the conservative management stratum (HR: 1.73; 95%CI: 1.40–2.13 and HR: 2.05; 95%CI: 1.69–2.47, respectively). Even in the initial aortic valve replacement stratum, moderate/severe anemia was associated with significantly increased risk for the primary outcome measure (HR: 2.12; 95%CI: 1.44–3.11). Moreover, moderate/severe anemia was associated with significantly increased risk for major bleeding while under conservative management (HR: 1.93; 95%CI: 1.21–3.06). These results warrant further study to explore whether better management of anemia would lead to improvement of clinical outcomes.