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Published on: June 12, 2021
Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention
Thomas Pilgrim1, Martina Rothenbühler2, Bindu Kalesan2
1Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Insights
Anemia and renal impairment significantly increase risks for patients undergoing Percutaneous Coronary Intervention (PCI). Combined conditions elevate mortality risk fourfold, highlighting the need for managing these co-morbidities in cardiovascular care.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Hematology
Background:
- Anemia and renal impairment are common co-morbidities in patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI).
- Disease progression and mortality in these patients are influenced by baseline characteristics and intermediate outcomes.
Purpose of the Study:
- To investigate clinical pathways from PCI through ischemic or hemorrhagic events to all-cause mortality.
- To analyze these pathways as a function of baseline anemia and renal impairment.
Main Methods:
- Prospective cohort study utilizing a multi-state analysis.
- Defined anemia by hemoglobin levels and renal impairment by creatinine clearance.
- Examined transitions from PCI to intermediate events (ischemic/hemorrhagic) and death.
Main Results:
- Anemia and renal impairment were present in 16.4% and 6.4% of 6029 PCI patients, respectively; 5.1% had both.
- The highest transition rate was from PCI to death (6.7%), followed by ischemic events (4.8%) and bleeding (3.4%).
- Patients with both anemia and renal impairment faced a 4-fold increased mortality risk compared to those without either condition.
Conclusions:
- A multi-state model demonstrated a clear risk gradient for adverse outcomes (bleeding, ischemic events, death) based on baseline hemoglobin and estimated glomerular filtration rate.
- Anemia and renal impairment significantly impact outcomes post-PCI, with combined conditions posing the highest risk.
Introduction:
Anemia and renal impairment are important co-morbidities among patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI). Disease progression to eventual death can be understood as the combined effect of baseline characteristics and intermediate outcomes.
Methods:
Using data from a prospective cohort study, we investigated clinical pathways reflecting the transitions from PCI through intermediate ischemic or hemorrhagic events to all-cause mortality in a multi-state analysis as a function of anemia (hemoglobin concentration <120 g/l and <130 g/l, for women and men, respectively) and renal impairment (creatinine clearance <60 ml/min) at baseline.
Results:
Among 6029 patients undergoing PCI, anemia and renal impairment were observed isolated or in combination in 990 (16.4%), 384 (6.4%), and 309 (5.1%) patients, respectively. The most frequent transition was from PCI to death (6.7%, 95% CI 6.1-7.3), followed by ischemic events (4.8%, 95 CI 4.3-5.4) and bleeding (3.4%, 95% CI 3.0-3.9). Among patients with both anemia and renal impairment, the risk of death was increased 4-fold as compared to the reference group (HR 3.9, 95% CI 2.9-5.4) and roughly doubled as compared to patients with either anemia (HR 1.7, 95% CI 1.3-2.2) or renal impairment (HR 2.1, 95% CI 1.5-2.9) alone. Hazard ratios indicated an increased risk of bleeding in all three groups compared to patients with neither anemia nor renal impairment.
Conclusions:
Applying a multi-state model we found evidence for a gradient of risk for the composite of bleeding, ischemic events, or death as a function of hemoglobin value and estimated glomerular filtration rate at baseline.
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