Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Jul 16;32(7):373–379. doi: 10.1002/clc.20542

The Influence of Anemia After Percutaneous Coronary Intervention on Clinical Outcomes

Sudhakar Sattur 1, Kishore J Harjai 2,, Arvin Narula 2, Srinivas Devarakonda 2, Pamela Orshaw 2, Karl Yaeger 2
PMCID: PMC6653541  PMID: 19609888

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. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (143.6 KB).

References

  • 1. O'Neill WW. Risk of bleeding after elective percutaneous coronary intervention. N Engl J Med 2006; 355: 1058–1060. [DOI] [PubMed] [Google Scholar]
  • 2.PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes: Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med 1998; 339: 436–443. [DOI] [PubMed] [Google Scholar]
  • 3. Chesebro JH, Knatterud G, Roberts R, et al. Thrombolysis In Myocardial Infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase clinical findings through hospital discharge. Circulation 1987; 76: 142–154. [DOI] [PubMed] [Google Scholar]
  • 4. Hill ME, Rosenwaike I. The Social Security Administration Death Master File: the completeness of death reporting at older ages. Soc Secur Bulletin 2001; 64: 45–51. [PubMed] [Google Scholar]
  • 5. Turner SJ, Ketch TR, Gandhi SK, Sane DC. Routine hematologic clinical tests as prognostic markers in patients with acute coronary syndromes. Am Heart J 2008; 155: 806–816. [DOI] [PubMed] [Google Scholar]
  • 6. McKechnie RS, Smith D, Montoye C, et al. Prognostic implication of anemia on in‐hospital outcomes after percutaneous coronary intervention. Circulation 2004; 110: 271–277. [DOI] [PubMed] [Google Scholar]
  • 7. Voeltz MD, Patel AD, Feit F, et al. Effect of anemia on hemorrhagic complications and mortality following percutaneous coronary intervention. Am J Cardiol 2007; 99: 1513–1517. [DOI] [PubMed] [Google Scholar]
  • 8. Kinnaird TD, Stabile E, Mintz GS, et al. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol 2003; 92: 930–935. [DOI] [PubMed] [Google Scholar]
  • 9. Lincoff AM, Bittl JA, Kleiman NS, et al. Comparison of bivalirudin versus heparin during percutaneous coronary intervention (the Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events [REPLACE]‐1 trial). Am J Cardiol 2004; 93: 1092–1096. [DOI] [PubMed] [Google Scholar]
  • 10. Rao SV, O'Grady K, Pieper KS, et al. A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes. J Am Coll Cardiol 2006; 47: 809–816. [DOI] [PubMed] [Google Scholar]
  • 11. Rao TLK, Montoya A. Cardiovascular, electrocardiographic and respiratory changes following acute anemia with volume replacement in patients with coronary artery disease. Anesth Dev. 1985; 12: 49–54. [Google Scholar]
  • 12. Mangano DT, Browner WS, Hollenberg M, et al. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 1990; 323: 1781–1788. [DOI] [PubMed] [Google Scholar]
  • 13. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001; 345: 1230–1236. [DOI] [PubMed] [Google Scholar]
  • 14. Fortune JB, Feustel PJ, Saifi J, et al. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987; 27: 243–247. [DOI] [PubMed] [Google Scholar]
  • 15. Casutt M, Seifert B, Pasch T, et al. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 1999; 27: 2194–2200. [DOI] [PubMed] [Google Scholar]
  • 16. Greenburg AG. A physiologic basis for red blood cell transfusion decisions. Am J Surg 1995; 170: 44S–48S. [DOI] [PubMed] [Google Scholar]
  • 17. Balla J, Jacob HS, Balla G, et al. Cell heme uptake from heme proteins: induction of sensitization and desensitization to oxidant damage. Proc Natl Acad Sci USA 1993; 90: 9285–9289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Blachman MA. Transfusion associated immunomodulation and universal white cell reduction: are we putting the cart before the horse. Transfusion 1999; 39: 1–9. [DOI] [PubMed] [Google Scholar]
  • 19. Hebert PC, Wells G, Blajchman MA, et al; Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340: 409–417. [DOI] [PubMed] [Google Scholar]
  • 20. Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001; 29: 227–234. [DOI] [PubMed] [Google Scholar]
  • 21. Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007; 116(5): 471–479. [DOI] [PubMed] [Google Scholar]
  • 22. Carson JL, Terrin ML, Barton FB, et al. A pilot randomized trial comparing symptomatic vs. hemoglobin‐level‐driven red blood cell transfusions following hip fracture. Transfusion 1998; 38 522–529. [DOI] [PubMed] [Google Scholar]
  • 23. Dunkelgrun M, Hoeks SE, Welten GM, et al. Anemia as an independent predictor of perioperative and long‐term cardiovascular outcome in patients scheduled for elective vascular surgery. Am J Cardiol 2008; 101: 1196–1200. [DOI] [PubMed] [Google Scholar]
  • 24. Weiner DE, Tighiouart H, Vlagopoulos PT, et al. Effects of anemia and left ventricular hypertrophy on cardiovascular disease in patients with chronic kidney disease. J Am Soc Nephrol 2005; 16: 1803–1810. [DOI] [PubMed] [Google Scholar]
  • 25. Anand I, McMurray JJ, Whitmore J, et al. Anemia and its relationship to clinical outcome in heart failure. Circulation 2004; 110(2): 149–154. [DOI] [PubMed] [Google Scholar]
  • 26. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999; 340: 115–126. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES