Risk stratification algorithm for clinical outcomes in anemic patients undergoing percutaneous coronary intervention
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Updated: Jul 18, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Bingbing Ke1, Renchun Gong2, Aidong Shen1
1Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Insights
Hemoglobin levels during and after percutaneous coronary intervention (PCI) predict major adverse cardiovascular and cerebral events (MACCE). Monitoring hemoglobin can help stratify risk in anemic PCI patients.
Area of Science:
- Cardiology
- Hematology
- Medical Informatics
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Anemia is a prevalent comorbidity in patients undergoing PCI.
- The relationship between hemoglobin levels and adverse cardiovascular outcomes post-PCI requires further investigation.
Purpose of the Study:
- To examine the association between baseline and visit hemoglobin levels and major adverse cardiovascular and cerebral events (MACCE) in PCI patients.
- To develop and validate risk stratification models for predicting MACCE in this population.
Main Methods:
- Retrospective cohort study of 8,298 PCI patients (2013-2020).
- Multivariate Cox proportional hazards models and machine learning algorithms (Gradient Boosting) were used for analysis.
- Model performance was assessed using Brier scores and receiver-operating characteristic curves.
Main Results:
- A total of 1,636 patients (19.71%) experienced MACCE during a median 4-year follow-up.
- Visit hemoglobin and hemoglobin change were significantly associated with MACCE risk (HR < 1).
- Low estimated glomerular filtration rate and high HbA1c were key predictors; a risk tree model identified high-risk patients.
Conclusions:
- Hemoglobin levels during and after PCI are more predictive of MACCE than baseline levels.
- Optimizing hemoglobin levels may improve long-term prognosis for anemic PCI patients.
- A novel risk stratification model can enhance screening for high-risk anemic patients undergoing PCI.
Background:
To explore the crosstalk between baseline or visit hemoglobin and major adverse cardiovascular and cerebral events (MACCE) in percutaneous coronary intervention (PCI) patients and to construct risk stratification models to predict MACCE amongst these patients.
Materials And Methods:
We conducted a retrospective cohort in patients undergoing PCI procedures at Beijing Friendship Hospital between January 2013 and December 2020. Multivariate Cox proportional hazards models were employed for data analyses. The composite MACCE was the primary endpoint and we used machine learning algorithms to evaluate risk factors associated with MACCE. Model performance was measured using Brier scores and receiver-operating characteristic curves. The association between risk factors and MACCE probability was examined using partial dependency plots.
Results:
8,298 PCI-treated patients were enrolled in the study. 1,919 of these patients had anemia. During a four-year median follow-up period, 1,636 patients (19.71%) had MACCE. The visit hemoglobin and hemoglobin change was associated with higher risk of MACCE respectively (visit hemoglobin: hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.98-0.99; p < 0.001; hemoglobin change: HR: 0.99; 95%CI: 0.98-0.99; p < 0.001). Gradient Boosting (GB) was the BPM, with a mean C-statistic value of 0.78 (95% CI: 0.76-0.80) for predicting MACCE (Brier score: 0.26). The best indicator for MACCE was a low estimated glomerular filtration rate [eGFR] (71 mL/min/1.73m2) at admission, followed by a high serum HbA1c (6.6%) level. A simple risk tree successfully classified patients (17-40.5%) with increased risks of MACCE. The high- vs. low-risk HR for MACCE was 2.04 (95% CI: 1.48-2.82).
Conclusions:
Visit hemoglobin and long-term hemoglobin changes were more predictive of MACCE risk than baseline hemoglobin levels. Our findings indicated that increasing hemoglobin levels might improve the long-term prognosis of anemia patients. We established a new risk stratification model for MACCE, which may more efficiently prioritize targeted screening for at-risk anemic patients undergoing PCI.
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