The Impact of Anemia on Long-Term Clinical Outcome in Patients Undergoing Revascularization With the Unrestricted Use of Drug-Eluting Stents

Abstract

Background— Anemia is frequent among patients with cardiovascular disease and adversely affects prognosis. The objective of this analysis was to assess the impact of anemia on long-term clinical outcomes among patients undergoing percutaneous coronary intervention (PCI) with the unrestricted use of drug-eluting stents (DES). Methods and Results— Between April 2002 to March 2009, 6528 consecutive patients underwent PCI with the unrestricted use of DES. Among patients with anemia according to the criteria by the World Health Organization (WHO) (hemoglobin <130 g/L for men and <120 g/L for women, respectively) patients below the 25 th percentile separately for men and women were defined to have severe anemia. We compared clinical outcomes among patients with severe anemia and no/mild anemia during long-term follow-up through 4 years. Whereas 21.6% of patients were found to have anemia according to the WHO definition, 347 patients (5.5%) had severe anemia (mean hemoglobin, 98±11 g/L). Severe anemia was more prevalent among the elderly ( P <0.001), diabetics ( P <0.001), and patients with chronic kidney disease ( P <0.001). In adjusted analyses, severe anemia was associated with an increased risk of death (hazard ratio, 1.86; 95% confidence interval, 1.37–2.52; P <0.0001), cardiac death (hazard ratio, 2.32; 95% confidence interval, 1.57–3.43; P <0.0001), and myocardial infarction (hazard ratio, 2.02; 95% confidence interval, 1.36–3.01; P =0.00054) as compared with no/mild anemia without significant interaction across sexes ( P =0.86) and acute coronary syndromes ( P =0.61) and a trend toward a particularly high risk of mortality among anemic patients <65 years of age ( P =0.07). Severe anemia resulted in a greater risk of overall definite stent thrombosis (hazard ratio, 2.59; 95% confidence interval, 1.48–4.54; P =0.00089). Conclusions— Severe anemia is common among patients undergoing PCI with the unrestricted use of DES and adversely affects long-term prognosis, including survival.

Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia

“…However, other studies do not show that platelet or leukocyte counts at presentation are predictive of subsequent vascular events [12,14]. In contrast with the observations of a recent study [26], but in keeping with the findings of an earlier study on a similar population [12], multivariate analysis excludes an association between either cardiovascular risk factors or JAK2 mutation and subsequent vascular events. The results of the cumulative analysis conducted on combined thrombotic and hemorrhagic events (primary endpoint), explain at least in part, how cell dynamism contributes to vascular events in ET.…”

Admission Haemoglobin Levels and Its Related Factors at Percutaneous Coronary Intervention for the Management of Acute Coronary Syndrome in Octogenarian Patients: Assessment of Gender Differences and In-Hospital Outcomes

“…Nikolsky et al [15] showed that anaemia predicted death in patients with myocardial infarction treated with primary angioplasty. Recently, Pilgrim et al [16] demonstrated that severe anaemia is common among patients undergoing PCI with the unrestricted use of drug eluting stent. Also, anaemia is associated with overall definite stent thrombosis (hazard ratio, 2.59; 95% confidence interval, 1.48-4.54; P=0.00089) and adversely affects long-term prognosis, including survival.…”

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

“…Interestingly, in addition to bleeding, the incidence of atherothrombotic events is also higher in patients with anemia who undergo PCI (6). One obvious cause for this enhanced propensity is premature discontinuation of DAPT secondary to bleeding, which, particularly after implantation of drug-eluting stents (DES), is associated with higher incidence of probable or definite stent thrombosis (5,6). Furthermore, anemia secondary to subclinical malignancy or inflammatory processes is associated with other blood dyscrasias (13-15), which may predispose anemic patients to more ischemic events.…”

“…The existing data, almost exclusively from prospective analysis of clinical cohorts or retrospective post-hoc analysis of data from large randomized clinical trials designed to investigate other specific endpoints, point to anemia as a strong independent predictor of major adverse cardiac outcomes (MACE), major bleeding and mortality in patients undergoing PCI (4)(5)(6). Some of the published studies have utilized rigorous statistical methods to adjust for all known and measurable variables that can interact with anemia, nevertheless the associations inferred from these studies, while providing valuable insights, remain hypothesis generating.…”

“…In the context of CAD, anemia, especially in more severe forms, can result in repeated myocardial ischemia especially under states with higher metabolic demands such as exertion (9), and can particularly compound the already jeopardized oxygenation of the myocardium during ACS (10). For patients undergoing PCI, anemia can be a marker for existence of multiple co-morbidities such as advanced age, chronic kidney disease, diabetes and autoimmune disease (4,5), all of which have firmly established negative impacts on MACE and mortality. Moreover, anemia, as the consequence of certain specific underlying etiologies, may worsen by PCI and the pharmacotherapy initiated peri-procedurally and after PCI.…”