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Prognostic Impact of Baseline Hemoglobin Levels on Long-Term Thrombotic and Bleeding Events After Percutaneous
Kazuya Nagao1, Hirotoshi Watanabe2, Takeshi Morimoto3
1Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan.
Insights
Lower baseline hemoglobin, even within the normal range, significantly increases long-term risks for bleeding, ischemic stroke, and mortality after percutaneous coronary intervention (PCI). This highlights the importance of monitoring hemoglobin levels in patients undergoing PCI.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- The association between baseline hemoglobin levels and long-term adverse events following percutaneous coronary interventions (PCI) requires further clarification.
- Understanding this relationship is crucial for optimizing patient management and outcomes after PCI.
Purpose of the Study:
- To evaluate the clinical impact of baseline hemoglobin levels on long-term ischemic and bleeding risks in patients undergoing PCI.
- To determine if hemoglobin levels within the normal range influence these risks.
Main Methods:
- Pooled individual patient data from three PCI studies involving 19,288 patients.
- Patients were categorized into four groups based on baseline hemoglobin levels: high-normal (≥14.0 g/dL), low-normal (13.0-13.9 g/dL men, 12.0-13.9 g/dL women), mild anemia (11.0-12.9 g/dL men, 11.0-11.9 g/dL women), and moderate/severe anemia (<11.0 g/dL).
- Median follow-up was 3 years, with analysis of risks for bleeding, myocardial infarction, ischemic stroke, and mortality.
Main Results:
- Lower hemoglobin levels (low-normal, mild anemia, moderate/severe anemia) were associated with significantly increased risks of major bleeding compared to high-normal hemoglobin.
- Moderate/severe anemia significantly increased the risk of the composite ischemic endpoint (myocardial infarction/ischemic stroke).
- All lower hemoglobin groups showed significantly increased risks for ischemic stroke and mortality compared to the high-normal group, indicating a dose-response relationship.
Conclusions:
- Decreasing baseline hemoglobin levels are incrementally associated with higher long-term risks of major bleeding, ischemic stroke, and mortality after PCI.
- Even hemoglobin levels within the normal range, when lower, correlate with increased ischemic and bleeding risks, suggesting a continuum of risk.
- These findings underscore the importance of considering baseline hemoglobin as a prognostic marker in patients undergoing PCI.
Abstract:
Background Association of baseline hemoglobin levels with long-term adverse events after percutaneous coronary interventions has not been yet thoroughly defined. We aimed to assess the clinical impact of baseline hemoglobin on long-term ischemic and bleeding risk after percutaneous coronary intervention. Methods and Results Using the pooled individual patient-level data from the 3 percutaneous coronary intervention studies, we categorized 19 288 patients into 4 groups: high-normal hemoglobin (≥14.0 g/dL; n=7555), low-normal hemoglobin (13.0-13.9 g/dL in men and 12.0-13.9 g/dL in women; n=5303), mild anemia (11.0-12.9 g/dL in men and 11.0-11.9 g/dL in women; n=4117), and moderate/severe anemia (<11.0 g/dL; n=2313). Median follow-up duration was 3 years. Low-normal hemoglobin, mild anemia, and moderate/severe anemia correlated with significant excess risk relative to high-normal hemoglobin for GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Trial) moderate/severe bleeding, with adjusted hazard ratios of 1.22 (95% CI, 1.04-1.44), 1.73 (95% CI, 1.47-2.04), and 2.31 (95% CI, 1.92-2.78), respectively. Moderate/severe anemia also correlated with significant excess risk relative to high-normal hemoglobin for the ischemic composite end point of myocardial infarction/ischemic stroke (adjusted hazard ratio, 1.33; 95% CI, 1.11-1.60), whereas low-normal hemoglobin and mild anemia did not. However, the excess risk of low-normal hemoglobin, mild anemia, and moderate/severe anemia relative to high-normal hemoglobin remained significant for ischemic stroke and for mortality. Conclusions Decreasing baseline hemoglobin correlated with incrementally higher long-term risk for major bleeding, ischemic stroke, and mortality after percutaneous coronary intervention. Even within normal range, lower baseline hemoglobin level correlated with higher ischemic and bleeding risk.
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