Prognostic Implications of Hemoglobin Drop With and Without Overt Bleeding After Percutaneous Coronary Intervention

Although most established bleeding definitions primarily emphasize overt bleeding, endpoints from major clinical trials and studies have historically defined major bleeding to include a periprocedural hemoglobin drop of ≥3.0 g/dL. However, the clinical relevance of this laboratory-based criterion, particularly without overt bleeding, remains uncertain.

The authors investigated the prognostic implication of a periprocedural hemoglobin drop of ≥3.0 g/dL, especially without overt bleeding.

Consecutive patients were analyzed from a Japanese registry between 2008 and 2021 after percutaneous coronary intervention (PCI). Patients were classified by hemoglobin drop (≥3.0 g/dL decrease between pre- and post-PCI) and overt bleeding. Cox regression assessed associations between these groups and 2-year major adverse cardiac events (MACE, such as all-cause mortality, acute coronary syndrome, heart failure hospitalization, and stroke).

Among 7,145 patients (mean age: 69 years; 77.0% male), 73 (1.0%) had both overt bleeding and hemoglobin drop; 85 (1.2%) had overt bleeding only; 590 (8.3%) had hemoglobin drop only; and 6,397 (89.5%) had no bleeding (reference). MACE occurred in 872 (12.2%; 95% CI: 11.5-13.0) patients during the median follow-up period of 730 (Q1-Q3: 730-730) days. MACE incidence was 30.1% (95% CI: 19.9-42.0) in patients with overt bleeding and hemoglobin drop, with higher risk than those without bleeding (adjusted HR: 2.16; 95% CI: 1.37-3.42). Only those patients with hemoglobin drop were not at increased risk of MACE (adjusted HR: 1.20; 95% CI: 0.89-1.60).

Hemoglobin drop with overt bleeding after PCI was associated with increased 2-year MACE risk, whereas hemoglobin drop without overt bleeding had less prognostic relevance, highlighting the importance of clinical context in evaluating post-PCI bleeding.