Shedding blood: anemia and adverse events after percutaneous coronary intervention (PCI)

Galougahi, Keyvan Karimi; Karmpaliotis, Dimitri; Kirtane, Ajay J.; Ali, Ziad A.

doi:10.21037/jtd.2016.02.29

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Low aHb levels also lead to a redistribution of blood flow from the subendocardial to the subepicardial myocardial layers, and together this can trigger myocardial necrosis [27,28]. In the setting of MI, this can promote arrhythmias, which further impair the already compromised myocardium [10,29].…”

Section: Discussionmentioning

confidence: 99%

Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial infarction

Kanic

Kompara

Suran

et al. 2022

Bosn J of Basic Med Sci

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Patients with a history of myocardial infarction (MI) and lower admission hemoglobin (aHb) levels have a worse outcome than patients with higher aHb, but lower or similar peaks in enzymatic infarct size. Hemoglobin levels are positively correlated with body surface area (BSA), which is positively correlated with cardiac mass. We hypothesized that patients with lower aHb suffer comparatively greater myocardial injury. We examined the relationships between aHb, and troponin (Tn) normalized to BSA (Tn/BSA) and its association with 30-day mortality. Data from 6055 patients, who were divided into seven groups based on their aHb at 10g/L intervals, were analyzed, and the groups were compared. The relationships between aHb and Tn/BSA and between Tn/BSA and 30-day mortality were assessed. Patients with higher aHb levels had greater BSA (p<0.0001). A negative relationship between aHb and log10Tn/BSA was observed in the entire group, and in men and women separately (p<0.0001, p<0.0001, and p=0.013, respectively). The log10Tn/BSA value was associated with 30-day mortality in the entire group, and in men and women separately (p<0.0001, p=0.014, and p<0.0001, respectively). Our finding suggests that a similar peak Tn value in patients with lower aHb means comparatively greater myocardial injury relative to cardiac mass. This hypothesis helps to explain the worse outcomes in patients with lower aHb. According to our findings, troponin should be indexed to BSA to provide comparable information on cardiac injury relative to cardiac mass. Whether this relationship is causal remains to be clarified.

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Section: Discussionmentioning

confidence: 99%

Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial infarction

Kanic

Kompara

Suran

et al. 2022

Bosn J of Basic Med Sci

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“…Previous studies consistently demonstrated that anemic patients underwent PCI were associated with significantly higher mortality and major adverse cardiovascular events (MACE) than non‐anemic patients . However, as several studies had suggested that anemia was no longer associated with increased mortality after adjustment for potential confounders, whether anemia was an independent predictor of adverse outcomes after PCI, that is, outcomes were driven by anemia per se or by higher baseline risks, was under debate . Furthermore, some studies indicated that anemia was only associated with poorer outcomes in patients with severe anemia but not in those with mild or moderate anemia, and some studies suggested that it was post procedural anemia that was independently associated with MACE .…”

Section: Introductionmentioning

confidence: 99%

Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data

Jiang

Gao

Song

et al. 2018

J Interven Cardiology

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Objectives: To investigate the impact of anemia on 2-year outcomes in patients undergoing contemporary percutaneous coronary intervention (PCI).Background: Whether anemia is an independent predictor of adverse outcomes after PCI is under debate.Methods: A total of 10 717 consecutive patients who underwent PCI with available hemoglobin values at Fuwai Hospital were collected. Clinical outcomes were compared between patients with and without anemia both before and after PCI procedure.Results: Totally, 1348 (12.5%) and 3111 (29.0%) patients presented with pre-and post-PCI anemia according to World Health Organization criteria (hemoglobin level <120 g/L for women or <130 g/L for men), respectively. Anemic patients presented with more baseline clinical risks and more extensive coronary disease than those without anemia. During 2-year follow-up, patients with pre-PCI anemia had higher incidence of bleeding and stroke than those without pre-PCI anemia. Patients with post-PCI anemia experienced higher incidence of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), bleeding, and major adverse cardiovascular events (MACE) than those without post-PCI anemia.Survival analyses were performed using multivariable Cox proportional hazards models both before and after propensity score matching. Pre-PCI anemia was not an independent risk factor of any adverse clinical events. Post-PCI anemia was not an independent risk factor of all-cause death, but was an independent risk factor of MI, TVR, and MACE.Conclusions: Pre-PCI anemia was not an independent risk factor of any adverse clinical events, while post-PCI anemia had a predictable value of MI, TVR, and MACE after PCI. K E Y W O R D S anemia, clinical outcomes, percutaneous coronary intervention

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“…Another difference between our study and prior studies is the exclusion of STEMI patients in our study (6,(45)(46)(47). With increased major bleeding complications during the procedure and after in the immediate-and long-term, these subsets of patients are more likely to have a poorer outcome post-PCI (45,51).…”

Section: Discussionmentioning

confidence: 87%

Clinical Characteristics and Long-Term Outcomes of Patients With Differing Haemoglobin Levels Undergoing Semi-Urgent and Elective Percutaneous Coronary Intervention in an Asian Population

Soh

Sia

Djohan

et al. 2022

Front. Cardiovasc. Med.

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IntroductionThis study aimed to investigate the impact of anaemia on long-term clinical outcomes in patients who underwent semi-urgent and elective percutaneous coronary intervention (PCI) in an Asian population. Although the effects of anaemia on outcomes in Asian patients are well studied for acute coronary syndrome, its impact on Asian patients undergoing semi-urgent and elective PCI is unclear.MethodsThis was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from January 1, 2014, to December 31, 2015, at a tertiary academic centre. A total of 1,685 patients were included. They were stratified into three groups: normal (≥12 g/dL), intermediate (10–11.9 g/dL), and low (<10 g/dL) haemoglobin levels. Demographics, risk factors, and end-points including the 5-point major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation), cardiovascular death, and bleeding events were analysed.ResultsPatients in intermediate and low haemoglobin level groups were older with more comorbidities. Compared to the normal haemoglobin level group, low haemoglobin level group patients were associated with an increased risk of composite endpoints of all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation [adjusted hazard ratio (aHR) 1.89, 95% confidence interval (CI):1.22, 2.92; p = 0.004]. This was driven by the increased risk of target lesions revascularisation observed in the low haemoglobin level group compared to the normal haemoglobin level group (aHR 17.74, 95% CI: 1.74, 180.80; p = 0.015). The patients in the low haemoglobin level group were also associated with a higher risk of bleeding events compared to the normal haemoglobin level group (aHR 7.18, 95% CI: 1.13, 45.40; p = 0.036).ConclusionIn our Asian cohort, patients with anaemia undergoing PCI were associated with a higher comorbid burden. Despite adjustments for comorbidities, these patients had higher mortality and worse cardiovascular outcomes following contemporary PCI.

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Shedding blood: anemia and adverse events after percutaneous coronary intervention (PCI)

Cited by 7 publications

References 24 publications

Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial infarction

Untangling the relationship between hemoglobin, peak troponin level, and mortality in patients with myocardial infarction

Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data

Clinical Characteristics and Long-Term Outcomes of Patients With Differing Haemoglobin Levels Undergoing Semi-Urgent and Elective Percutaneous Coronary Intervention in an Asian Population

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