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Effect of hemoglobin level on long-term all-cause mortality after percutaneous coronary intervention in
Shyam Poludasu1, Jonathan D Marmur, Jeremy Weedon
1Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, USA.
Insights
Anemia independently predicts long-term mortality in African-Americans after percutaneous coronary intervention (PCI). Lower hemoglobin (Hgb) levels significantly increase mortality risk in this population undergoing PCI.
Area of Science:
- Cardiology
- Hematology
- Public Health
Background:
- Anemia is a known predictor of mortality post-percutaneous coronary intervention (PCI).
- African-Americans exhibit lower hemoglobin (Hgb) levels than Caucasians.
- The specific impact of anemia on long-term mortality in African-Americans undergoing PCI remains understudied.
Purpose of the Study:
- To investigate the association between anemia and long-term mortality in African-American patients undergoing PCI.
- To determine if baseline hemoglobin levels are an independent predictor of mortality in this demographic.
Main Methods:
- Retrospective analysis of 715 African-American patients from a bolus-only glycoprotein IIb/IIIa database.
- Patients were categorized as anemic (Hgb <13 g/dl for men, <12 g/dl for women) or non-anemic.
- Cox proportional hazards models were used to adjust for clinical and procedural factors.
Main Results:
- Anemia was associated with significantly higher unadjusted mortality (84% survival in anemic vs. 94% in non-anemic).
- After adjustment, Hgb was a strong independent predictor of all-cause mortality (HR 2.0).
- Analysis of Hgb as a categorical variable confirmed its significant association with mortality risk.
Conclusions:
- Baseline hemoglobin is a significant and independent predictor of long-term all-cause mortality in African-Americans undergoing PCI.
- Anemia represents a critical risk factor for adverse outcomes in this patient population.
- Further research into managing anemia in African-Americans undergoing PCI may improve long-term survival.
Abstract:
Anemia has been shown to be an independent predictor of long-term mortality after percutaneous coronary intervention (PCI). African-Americans are known to have lower hemoglobin (Hgb) levels compared with Caucasians. The impact of anemia on long-term mortality in African-Americans undergoing PCI is unknown. We evaluated a total of 715 African-American patients (313 patients with anemia and 402 patients without anemia as defined by the World Health Organization [Hgb <13 g/dl for men and <12 g/dl for women]) using data from our bolus-only glycoprotein IIb/IIIa database. After a median follow-up of 3.2 years (interquartile range 2.4 to 3.8), there were a total of 72 (10%) deaths. Survival rate was 84% in the anemic group compared with 94% in the control group (hazard ratio [HR] 2.8, unadjusted p <0.001 by log-rank test). After adjustment for baseline clinical and procedural characteristics using a Cox proportional hazards model, Hgb as a dichotomous variable was a strong and independent predictor of all-cause mortality during the follow-up period (HR for death 2.0, 95% confidence interval 1.2 to 3.4, adjusted p = 0.012). Also, when Hgb was analyzed as a categorical variable having 3 groups with empirically determined cutoffs at <11.1, > or =11.1 to <12.7, and > or =12.7 g/dl, the effect remained significant (adjusted p = 0.008), with a HR of 2.3 for the group with lowest Hgb compared with the group with highest value (HR 2.6 for group with Hgb > or =11.1 to <12.7 compared with the group with the highest Hgb value). In conclusion, baseline Hgb is a strong and independent predictor of all-cause long-term mortality in African-Americans undergoing PCI.