Related Experiment Video
Updated: Dec 25, 2025
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Anemia as an independent predictor of adverse outcomes after carotid revascularization
Hanaa Dakour-Aridi1, Michael Tianhao Ou2, Satinderjit Locham1
1Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla, Calif.
Insights
Preoperative anemia significantly increases the risk of major adverse cardiac events and 30-day mortality following carotid revascularization procedures like CEA and CAS. Anemia should be considered in patient risk assessments.
Area of Science:
- Vascular Surgery
- Cardiology
- Hematology
Background:
- Anemia is a known risk factor for poor outcomes in major vascular surgery.
- Carotid revascularization procedures are less physiologically stressful than other vascular interventions.
- This study investigates the link between preoperative anemia and adverse events specifically after carotid revascularization.
Purpose of the Study:
- To evaluate the association between preoperative anemia and major adverse events after carotid endarterectomy (CEA) and carotid artery stenting (CAS).
- To assess the impact of anemia on in-hospital major adverse cardiac events (MACEs) and 30-day mortality.
- To determine if the association differs between CEA and CAS procedures.
Main Methods:
- Analysis of 102,719 patients from the Vascular Quality Initiative database (2012-2018).
- Anemia defined as hemoglobin <12 g/dL (women) or <13 g/dL (men).
- Multivariable logistic analysis and 1:1 coarsened exact matching used to assess outcomes.
Main Results:
- 34.8% of patients were anemic; anemic patients were older with more comorbidities.
- Anemic patients had higher rates of in-hospital MACEs (2.8% vs 1.9%) and 30-day mortality (0.9% vs 0.4%).
- Anemia correlated with 18% higher odds of MACEs and 74% higher odds of 30-day mortality.
Conclusions:
- Preoperative anemia is linked to increased adverse events and mortality after CEA and CAS.
- Anemia should be incorporated into preoperative risk stratification for carotid revascularization.
- Further research is needed on correcting anemia and long-term outcomes.
Background:
Anemia has been identified as a risk factor for postoperative morbidity and mortality after major vascular procedures. Carotid revascularization carries less cardiac morbidity and physiologic stress compared with other vascular interventions. This study evaluated the association between preoperative anemia and major adverse events after carotid revascularization.
Methods:
Patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) between January 2012 and June 2018 in the Vascular Quality Initiative database were identified. Anemia was defined as a preoperative hemoglobin level of <12 g/dL in women and <13 g/dL in men. Multivariable logistic analysis and 1:1 coarsened exact matching were used to study the association between preoperative anemia and in-hospital major adverse cardiac events (MACEs), defined as a composite of stroke, death, and myocardial infarction, and between anemia and 30-day mortality after CEA and CAS.
Results:
Of 102,719 patients included in the analysis, 34.8% were anemic (CEA, 34.1%; CAS, 37.8%; P < .001). Anemic patients were older and had more medical comorbidities compared with nonanemic patients. In-hospital MACEs (2.8% vs 1.9%; P < .001) and 30-day mortality (0.9% vs 0.4%; P < .001) were higher among anemic patients. On multivariable analysis, anemia was associated with 18% higher odds of in-hospital MACEs (odds ratio, 1.18; 95% confidence interval, 1.07-1.31, P = .001) and 74% higher odds of 30-day mortality (odds ratio, 1.74; 95% confidence interval, 1.40-2.17, P < .001). Coarsened exact matching showed similar results. The association between preoperative anemia and adverse outcomes was similar in both CAS and CEA and in symptomatic and asymptomatic patients (P interaction > .05).
Conclusions:
Anemia is associated with increased odds of adverse events after CEA and CAS. It should be factored into the preoperative risk assessment of patients undergoing carotid revascularization. Prospective studies are needed to study the effectiveness of correcting low preoperative hemoglobin levels in these patients and the association between anemia and long-term outcomes after CEA and CAS.
More Related Videos
05:35Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:27Disorders of Erythrocytes
Erythrocyte disorders can be broadly categorized into two main types: anemic and polycythemic conditions.
A low oxygen-carrying capacity of the blood due to the loss, lower production, or destruction of erythrocytes is termed anemia. Hemorrhagic anemia, for example, occurs when bleeding from an external wound or internal ulcer reduces erythrocyte counts.
On the other...
01:30Coronary Artery Disease I: Introduction
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:24Factors Affecting Erythropoiesis
Several factors influence the erythrocyte production rate, with tissue oxygen level being among the most critical. Intense exercise or high altitudes can cause tissue hypoxia, which triggers the kidneys to release more erythropoietin (EPO) into the bloodstream.
EPO then...