The Influence of Anemia After Percutaneous Coronary Intervention on Clinical Outcomes

Abstract

Background: Although the consequences of bleeding after percutaneous coronary intervention (PCI) are well documented, there are no data on the impact of post-PCI anemia (PPA) on clinical outcomes. Methods: We evaluated the incidence, predictors, and prognostic implications of PPA on clinical outcomes in 1415 PCI procedures. We compared clinical outcomes of patients with PPA (ie, nadir post-PCI hemoglobin <10 gm/dL) vs without PPA. In patients with PPA, we assessed the influence of thrombolysis in myocardial infarction (TIMI; major or minor) bleeding, drop in hemoglobin by ≥3 gm/dL, and use of blood transfusions on outcomes.Results: Post-PCI anemia developed in 124 (8.8%) patients. Of these, 50 (40%) suffered TIMI (major or minor) bleeding, 68 (55%) had a hemoglobin drop of ≥3 gm/dL, and 39 (32%) patients received blood transfusions. Compared to patients without PPA, those with PPA had greater incidence of 6 month death (6.5% vs 1.7 %, p = 0.003), 6 month major adverse cardiovascular event (MACE; death, reinfarction, or target vessel revascularization; 27.3% vs 14.5%, p = 0.0006), and long-term mortality (25.8% vs 8.7 %, p≤0.0001). After adjustment for baseline differences, PPA showed an independent association with 6 month MACE (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.5-3.9) and long-term mortality (hazard ratio [HR]: 1.3, 95% CI: 1.0-1.6). In patients who developed PPA, the occurrence of TIMI (major or minor) bleeding, hemoglobin drop of ≥3 gm/dL, and use of blood transfusions did not impact outcomes. conclusion: We found that PPA is common, occurs frequently in the absence of bleeding or significant drop in hemoglobin, and connotes poor long-term outcomes. IntroductionIn patients undergoing percutaneous coronary intervention (PCI) for stable or unstable coronary syndromes, antiplatelet and anticoagulant agents are frequently utilized to minimize ischemic complications. These agents are associated with significant risk of bleeding complications and anemia.

Diagnostic Blood Loss From Phlebotomy and Hospital-Acquired Anemia During Acute Myocardial Infarction

“…4,6,24 In our study, 1 in 5 patients who did not have baseline anemia (and did not undergo coronary bypass surgery) developed moderate to severe HAA.…”

Preprocedural hemoglobin predicts mortality following peripheral vascular interventions

“…It has also been shown that a low postprocedural H and a periprocedural H drop ! 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].…”

Factors related to a clinically silent peri-procedural drop in hemoglobin with coronary and peripheral vascular interventions

“…1,7,8,11,12,[18][19][20][21] Recent studies have shown that clinically silent peri-procedural blood loss is strongly associated with increased mortality and contrast-induced nephropathy. 22,23 The predictors of a clinically silent or subclinical periprocedural drop in hemoglobin have not been defined. We performed a retrospective analysis of a large cohort of patients undergoing both coronary and peripheral vascular percutaneous interventions to identify predictors of a subclinical drop in hemoglobin.…”