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Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study
Batla Falah1, Björn Redfors1,2,3, Duzhi Zhao1
1Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, United States.
Insights
Anemia is common in patients undergoing high-risk percutaneous coronary intervention (HRPCI) with Impella support. Anemia independently increases the risk of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hematology
Background:
- Anemia is prevalent in cardiovascular disease patients, linked to adverse outcomes.
- Limited data exists on anemia's impact in high-risk percutaneous coronary intervention (HRPCI).
Purpose of the Study:
- To evaluate the impact of anemia on patients undergoing Impella-supported HRPCI.
- To assess the association between anemia and major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding.
Main Methods:
- Analysis of patients from the PROTECT III study undergoing Impella-supported HRPCI.
- Stratification of patients into no anemia, mild anemia, and moderate/severe anemia groups based on WHO criteria.
- Comparison of MACCE and major bleeding events at 30 and 90 days across anemia groups.
Main Results:
- 37.9% had no anemia, 43.4% mild anemia, and 18.7% moderate/severe anemia.
- Anemia was associated with significantly higher MACCE rates at 30 and 90 days (p<0.05).
- Major bleeding events were also more frequent in anemic patients (p=0.002).
Conclusions:
- Baseline anemia is a common and independent predictor of MACCE and major bleeding in Impella-supported HRPCI.
- Anemia's significance as a prognostic factor warrants further investigation.
- Developing strategies to mitigate anemia-associated risks after HRPCI is crucial.
Background:
Anemia is prevalent among patients with cardiovascular disease and is associated with adverse outcomes. However, data regarding the impact of anemia in high-risk percutaneous coronary intervention (HRPCI) are limited.
Objectives:
This study aimed to evaluate the impact of anemia in patients undergoing Impella-supported HRPCI in the PROTECT III study.
Methods:
Patients undergoing Impella-supported HRPCI in the multicenter PROTECT III study were assessed for anemia based on baseline hemoglobin levels according to World Health Organization criteria. Patients were stratified into three groups, namely, no anemia, mild anemia, and moderate or severe anemia. Major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days, and major bleeding events were compared across groups.
Results:
Of 1,071 patients with baseline hemoglobin data, 37.9% had no anemia, 43.4% had mild anemia, and 18.7% had moderate or severe anemia. Anemic patients were older and more likely to have comorbidities. Anemia was associated with higher MACCE rates at 30 days (moderate to severe, 12.3%; mild, 9.8%; no anemia, 5.4%; p = 0.02) and at 90 days (moderate to severe, 18.7%; mild, 14.6%; none, 8.3%; p = 0.004). These differences persisted after adjustment for potential confounders at 30 and 90 days, and sensitivity analysis excluding dialysis showed similar results. Major bleeding at 30 days was also higher in anemic patients (5.5% vs. 1.2%, p = 0.002).
Conclusion:
Baseline anemia in Impella-supported HRPCI is common and independently associated with MACCE and major bleeding, emphasizing its significance as a prognostic factor. Specific management strategies to reduce anemia-associated MACCE risk after HRPCI should be examined. Clinical Trial Information Trial Name: The Global cVAD Study (cVAD)ClinicalTrial.gov Identifier: NCT04136392URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2.
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