Preprocedural hemoglobin predicts outcome in peripheral vascular disease patients undergoing percutaneous transluminal angioplasty

Toor, Iqbal; Jaumdally, Rumi; Moss, Mark S.; Babu, Suresh B

doi:10.1016/j.jvs.2009.03.041

Cited by 21 publications

(13 citation statements)

References 24 publications

(19 reference statements)

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“…6,11,28–31 Gupta et al demonstrated that preoperative anemia (HCT < 39%) was associated with a higher rate of 30-day mortality (2.4% vs. 1.2%) and cardiac events (2.3% vs. 1.2%) compared to non-anemic elderly patients undergoing elective vascular procedures in NSQIP. 29 A retrospective analysis of patients between 1990–2006 from a single institution also reported that the degree of anemia was inversely associated with not only 30-day but also 5-year MACE in 1,211 vascular patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Bodewes

Pothof

Darling

et al. 2017

Journal of Vascular Surgery

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Objective Preoperative anemia in elderly patients undergoing surgery is prevalent and associated with adverse events; however, the interaction with other risk factors in patients with chronic limb-threatening ischemia (CLTI) is not well described. The purpose of this study was to assess the association between lower hematocrit (HCT) on admission and postoperative outcomes after infrainguinal bypass surgery. Methods Patients with CLTI undergoing non-emergent infrainguinal bypass were identified in the targeted vascular NSQIP 2011–2014. Thirty-day outcomes were compared across preoperative HCT levels: severe (HCT ≤29%), moderate (HCT 29.1–34%), mild (HCT 34.1–39%), or no anemia (HCT >39%), with no anemia serving as the reference group for all analyses. Independent associations between levels of anemia and postoperative outcomes were established using multivariable logistic regression. A sensitivity analysis was performed to assess interactions between preoperative anemia and blood transfusions. Results We identified 5,081 patients undergoing bypass, of which 741 (15%) had severe, 1,317 (26%) moderate, 1,516 (30%) mild, and 1,507 (30%) no anemia. Anemic patients were older and more commonly suffered from tissue loss and comorbidities (e.g. hypertension, diabetes, and renal insufficiency) (all P<.001). After adjustment for baseline conditions, mortality was higher in those with severe (3.1%, OR: 2.8, [95% CI: 1.3–6.3]) and moderate anemia (3.0%, OR: 2.6 [1.2–5.5]) compared to those without anemia (0.7%). Severe anemia was independently associated with major amputation (6.9% vs. 3.3%, OR: 1.6 [1.01–2.6]) compared to no anemia. Anemia on admission was additionally associated with several other adverse outcomes, such as major adverse cardiovascular event (MACE) (severe: OR: 1.9 [1.1–3.0]; moderate: OR: 1.9 [1.3–2.9]; mild: OR: 1.6 [1.1–2.4]) and unplanned return to the operating room (severe: OR: 1.6 [1.2–2.1]; moderate: OR: 1.5 [1.2–1.8]; mild: OR: 1.3 [1.03–1.6]). Moreover, mortality associated with preoperative anemia was not different in patients receiving postoperative blood transfusions compared to those who did not, while MACE was significantly higher in patients with preoperative anemia and blood transfusions (interaction; P < .001) Conclusions Mortality and major adverse events in CLTI patients undergoing infrainguinal bypass are inversely associated with preoperative hematocrit levels, with the highest event rates in the most severely anemic patients. The correlation between anemia and MACE – but not mortality – was stronger in those patients receiving postoperative blood transfusions. Further research is needed to define an appropriate transfusion threshold and attention should be focused on how to best optimize anemic CLTI patients prior to intervention.

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Section: Discussionmentioning

confidence: 99%

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Bodewes

Pothof

Darling

et al. 2017

Journal of Vascular Surgery

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“…In one recent retrospective study of 101 patients undergoing nonemergent lower extremity PVI, preprocedural H level was shown to be associated with an unfavorable 14-month peripheral vascular outcome (a composite of all-cause mortality, limb amputation, and target lesion revascularization) [4]. A preprocedural H level of 10.5 AE 0.7 g/dl when compared with a H level of 13.9 AE 0.9 g/dl was associated with a 4.17 increased odds of an adverse peripheral vascular outcome (OR: 4.17; 95% CI: 1.56-11.16; P ¼ 0.004) and a preprocedural H level of 12.0 AE 0.4 g/dl when compared to a H level of 13.9 AE 0.9 g/dl was associated with a 2.99 times increased odds of an adverse peripheral vascular outcome (OR: 2.99; 95% CI: 1.14-7.53; P ¼ 0.03).…”

Section: Discussionmentioning

confidence: 99%

“…1 g/dl in patients undergoing percutaneous coronary intervention is associated with adverse outcomes [2,3]. The prognostic significance of baseline H in patients undergoing peripheral vascular interventions (PVI) is uncertain [4]. We evaluated the midterm prognostic significance of serum H by a retrospective analysis of a consecutive series of patients undergoing percutaneous PVI.…”

Section: Introductionmentioning

confidence: 99%

Preprocedural hemoglobin predicts mortality following peripheral vascular interventions

Jaffery

Shamai

White

2011

Cathet Cardio Intervent

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In patients undergoing PVI, preprocedural H was a significant predictor of 9-month all-cause mortality. The highest mortality rate was seen in patients with a preprocedural H level ≤ 10 g/dl. Preprocedural H level can be used in clinical practice to risk stratify patients being considered for PVI. Further investigation is needed to assess if optimization of H level preprocedure improves midterm mortality.

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“…Anemia was also found to be a strong predictor of both repeat EI including TVR and death in female patients with PAD. As a population, patients with PAD have been shown to have a high prevalence of anemia 24 . Poorer outcomes in anemic patients after PCI have been attributed to higher frequencies of cardiac comorbidities, poor nutritional status, and increasing patient age 25–27 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Poor Outcome in Female Patients Undergoing Endovascular Intervention

Abbas¹,

Goodman²,

Timmis³

et al. 2010

J Interven Cardiology

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Preprocedural hemoglobin predicts outcome in peripheral vascular disease patients undergoing percutaneous transluminal angioplasty

Cited by 21 publications

References 24 publications

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Preprocedural hemoglobin predicts mortality following peripheral vascular interventions

Predictors of Poor Outcome in Female Patients Undergoing Endovascular Intervention

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