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Periprocedural hemoglobin changes and myocardial injury in patients undergoing percutaneous coronary intervention
Keivan Alizadeh1, Saloomeh Pouralizadeh1, Sepideh Parchami-Ghazaee1
1Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Insights
Post-procedure hemoglobin drop in patients undergoing percutaneous coronary intervention (PCI) can predict adverse cardiac outcomes. Careful bleeding control during and after PCI may reduce the risk of cardiac enzyme elevation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biochemistry
Background:
- Percutaneous coronary intervention (PCI) carries risks, including periprocedural bleeding and myocardial injury.
- Blood loss during PCI, from puncture site hematomas and catheter aspiration, leads to a drop in hemoglobin levels.
Purpose of the Study:
- To evaluate the relationship between periprocedural hemoglobin levels and cardiac enzyme changes.
- To assess hemoglobin levels as a predictor of adverse cardiac outcomes in patients undergoing PCI.
Main Methods:
- 1012 patients with coronary artery disease undergoing PCI were studied.
- Hemoglobin levels were measured pre- and post-procedure; patients were classified as anemic or non-anemic.
- Cardiac enzymes (Troponin I and CK-MB) were measured serially post-procedure to define myocardial injury categories.
Main Results:
- While hemoglobin decreased post-procedure in all groups, patients with elevated Troponin I (TnI ≥ 0.06 µu/l) showed significantly lower post-procedure hemoglobin levels (P = 0.008).
- All categories of cardiac enzyme elevation were observed within the non-anemic group.
Conclusions:
- A drop in hemoglobin levels after PCI may predict adverse cardiac outcomes.
- Effective bleeding management during and after PCI is crucial for reducing the risk of post-procedural cardiac enzyme elevation.
Background:
Patients undergoing percutaneous coronary intervention are at serious risk of different complications such as periprocedural bleeding that can lead to myocardial injuries. Blood loss through puncture site hematoma formation and through catheter aspiration causes periprocedural hemoglobin drop.
Objectives:
Although percutaneous coronary intervention is an effective treatment of coronary artery disease, it seems necessary to investigate the impact of complications on outcomes including myocardial infarction and possible mortality. The purpose of this study was to evaluate the relationship between periprocedural hemoglobin levels and cardiac enzyme changes as a predictor of cardiac adverse outcomes in patients undergoing percutaneous coronary intervention.
Patients And Methods:
This study was conducted on 1012 consecutive patients with a diagnosis of coronary artery disease who underwent percutaneous coronary intervention. Hemoglobin levels were measured immediately before and post-procedurally and based on the baseline levels the patients were classified into anemic and non-anemic groups. The samples for TnI and CP-MB were collected before the procedure and at 8, 16, and 24 hours post-procedurally. The patients were stratified into three categories of myocardial injuries: patients with CK-MB ≥ 3×; those with TnI > 0.06 µu/l and individuals with both CK-MB ≥ 3× and TnI > 0.06 µu/l.
Results:
All categories divided by cardiac enzyme status either in positive or in negative groups were classified in non-anemic group. Although in all groups hemoglobin level decreased post-procedurally, in the second category (TnI ≥ 0.06) the positive patients had significantly lower hemoglobin amounts after the procedure (P = 0.008).
Conclusion:
Post-procedure hemoglobin dropping may be considered as a predictor of cardiac adverse outcome in patients undergoing PCI. We suggest that a good bleeding control during and after the procedure can reduce the risk of cardiac enzyme elevation post-procedurally.
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