Baseline anemia in patients undergoing percutaneous coronary intervention after an acute coronary syndrome—A paradox of high bleeding risk, high ischemic risk, and complex coronary disease

Yazji, Khaled; Abdul, Fairoz; Elangovan, Senthil; Haq, Muhammad Zia Ul; Ossei-Gerning, Nick; Morris, Keith; Anderson, Richard; Kinnaird, Tim

doi:10.1111/joic.12406

Cited by 27 publications

(19 citation statements)

References 30 publications

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“…The current analysis of over 1700 ACS patients undergoing PCI in a single university hospital centre in the United Kingdom confirms the high prevalence of anemia (26%) in patients undergoing PCI, with the commonest etiologies of anemia being chronic kidney disease (20%), followed by bleeding (18%), the presence of other chronic disease (13%), cancer (9%), and myeloproliferative disorders (7%). Importantly, in one third of patients the etiology could not be identified.…”

supporting

confidence: 52%

Editorial: Navigating the rough seas of anemia; caught between the devil and the deep blue sea

Mamas

Rao

2017

J Interven Cardiology

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Editorial: Navigating the rough seas of anemia; caught between the devil and the deep blue sea Scylla and Charybdis were mythical sea monsters that were on opposite sides of the Strait of Messina between Sicily and Italy. Scylla was a sixheaded sea monster on the Italian side of the strait and Charybdis was a whirlpool off the coast of Sicily. They were located close enough to each other that they posed a mortal threat to passing sailors; avoiding Charybdis meant passing too close to Scylla and vice versa. Odysseus, inGreek mythology was forced to choose which monster to confront while passing through the strait; he opted to pass by Scylla and lose only a few sailors, rather than lose his entire ship in the whirlpool. 1 Often in

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confidence: 52%

Editorial: Navigating the rough seas of anemia; caught between the devil and the deep blue sea

Mamas

Rao

2017

J Interven Cardiology

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“…There seems to be reciprocal feedback: the presence of comorbidities or the treatment used promotes the onset of anemia [ 48 – 53 ]. Anemia exacerbates the course of a number of diseases [ 51 , 54 – 56 ] and may be one of the factors that contribute to the need to perform certain medical procedures (e.g., coronary angiography) or hospitalization (especially due to heart failure) [ 42 , 54 , 57 ], and both procedures and hospitalizations may be conducive to the development of anemia [ 47 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, repeated hospitalizations, and age ≥ 80 years as indicators of anemia development in the older population

2018

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Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥ 60 in Poland over 2013–2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age ≥ 80 years (OR 2.29; 95%CI 1.19–4.42; P = 0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12–7.30; P = 0.029, three diseases OR 6.28; 95%CI 2.22–17.76; P = 0.001, four diseases OR 4.64; 95%CI 1.27–17.01; P = 0.021), and hospitalizations (OR 1.34; 95%CI 1.13–1.58; P = 0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P < 0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43–7.74, P = 0.005), heart failure (HR 2.94, 95%CI 1.33–6.50, P = 0.008), and cancer (HR 3.31, 95%CI 1.47–7.49, P < 0.004) were all significantly correlated with mortality. In patients ≥ 60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.

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“…Several studies addressed the prevalence of anemia on admission in the setting of ACS, 1 – 8 , 18 with estimates varying between 10% and 43% as summarized in Table 2 .…”

Section: Anemia and Acs: Epidemiology And Prognostic Impactmentioning

confidence: 99%

“…In both randomized trials and meta-analyses, anemia on admission is always related to worse outcome, being associated with increased mortality at different observation time points, as summarized in Table 3 . 3 – 6 , 8 , 9 , 18 …”

Section: Anemia and Acs: Epidemiology And Prognostic Impactmentioning

confidence: 99%

“… 1 , 2 As shown in Figure 1 , when considering overt anemia, 3 main determinants need to be considered: adequate erythro poiesis – that is, bone marrow function and adequate production of the specific growth factor; erythropoietin – that is, renal function – and preserved red blood cell (RBC) mass-to-plasma volume ratio – that is, hemodilution. 3 – 8 …”

Section: Introductionmentioning

confidence: 99%

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Anemia and acute coronary syndrome: current perspectives

Stucchi¹,

Cantoni²,

Piccinelli³

et al. 2018

VHRM

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Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of <13 g/dL for adult men and <12 g/dL for adult nonpregnant women. Subsequent studies identified different normal values according to race and age. Estimated prevalence of anemia on admission in the setting of an acute coronary syndrome (ACS) is between 10% and 43% of the patients depending upon the specific population under investigation. Furthermore, up to 57% of ACS patients may develop hospital-acquired anemia (HAA). Both anemia on admission and HAA are associated with worse short- and long-term mortality, even if different mechanisms contribute to their prognostic impact. Baseline anemia can usually be traced back to preexisting disease that should be specifically investigated and corrected whenever possible. HAA is associated with clinical characteristics, medical therapy and interventional procedures, all eliciting cardiovascular adaptive response that can potentially worsen myocardial ischemia. The intrinsic fragility of anemic patients may limit aggressive medical and interventional therapy due to an increased risk of bleeding, and could independently contribute to worse outcome. However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS. Besides identification and treatment of the underlying causes of anemia, the only readily available means to reverse anemia is red blood cell transfusion. The adequate transfusion threshold is still being debated, although solid evidence suggests reserving red blood cell transfusions for patients with Hb level <8 g/dL and considering it in selected cases with Hb levels of between 8 and 10 g/dL. No evidence supports the use of iron supplements and erythropoiesis-stimulating agents in the setting of ACS.

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Baseline anemia in patients undergoing percutaneous coronary intervention after an acute coronary syndrome—A paradox of high bleeding risk, high ischemic risk, and complex coronary disease

Abstract: Patients with anemia present with high ischemia and bleed risk scores, complex coronary disease, and have adverse outcomes. Incomplete revascularization was associated with worse survival regardless of anemia status.

Cited by 27 publications

References 30 publications

Editorial: Navigating the rough seas of anemia; caught between the devil and the deep blue sea

Editorial: Navigating the rough seas of anemia; caught between the devil and the deep blue sea

Comorbidities, repeated hospitalizations, and age ≥ 80 years as indicators of anemia development in the older population

Anemia and acute coronary syndrome: current perspectives

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