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Impact of baseline anemia on outcomes following chronic total occlusion percutaneous coronary intervention
Chloe Kharsa1, Gal Sella1, Yasser Sammour1
1Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX, 77030, United States of America.
Insights
Anemia in patients undergoing chronic total occlusion percutaneous coronary intervention (CTO PCI) is linked to worse outcomes, including higher mortality and target lesion failure. This highlights anemia as a key risk factor needing careful management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hematology
Background:
- Anemia is a frequent comorbidity in patients undergoing percutaneous coronary intervention (PCI).
- The prognostic significance of anemia in chronic total occlusion (CTO) PCI is not well understood.
- Anemia may indicate worse outcomes post-PCI.
Purpose of the Study:
- To assess procedural and clinical outcomes in patients with and without anemia undergoing CTO PCI.
- To utilize real-world data from a high-volume tertiary care center for evaluation.
Main Methods:
- Retrospective observational study of 504 patients undergoing CTO PCI (January 2018 - December 2023).
- Patients categorized based on World Health Organization anemia criteria.
- Primary endpoints: procedural success, one-year all-cause mortality, target lesion revascularization (TLR). Secondary endpoints: target lesion failure (TLF), in-hospital complications.
Main Results:
- 32.3% of patients had anemia; they were older with more comorbidities (CKD, heart failure).
- Anemia patients showed similar procedural success but higher in-hospital complications and one-year mortality (18.1% vs. 5.0%; HR=4.0).
- Anemia independently predicted one-year mortality and TLF, while anemia severity did not correlate with mortality.
Conclusions:
- Pre-procedural anemia is associated with significantly worse in-hospital and long-term outcomes after CTO PCI.
- Anemia serves as a marker of systemic vulnerability in this patient group.
- Comprehensive risk stratification and multidisciplinary care are crucial for high-risk patients with anemia undergoing CTO PCI.
Background:
Anemia is a common comorbidity in patients undergoing percutaneous coronary intervention (PCI) and may signal worse post-procedural outcomes. Its prognostic impact in the context of chronic total occlusion (CTO) PCI remains underexplored.
Objectives:
To evaluate procedural and clinical outcomes following CTO PCI in patients with and without anemia using real-world data from a high-volume tertiary care center.
Methods:
We conducted a retrospective observational study using data from 504 patients who underwent CTO PCI between January 2018 and December 2023 at Houston Methodist. Patients were stratified by anemia status, defined using World Health Organization hemoglobin thresholds. Primary endpoints included procedural success, one-year all-cause mortality, and target lesion revascularization (TLR). Secondary endpoints included target lesion failure (TLF) and in-hospital complications.
Results:
Of the cohort, 163 patients (32.3 %) had anemia. Patients with anemia were older, more often female, and had a greater burden of comorbidities, including CKD and heart failure. Despite similar lesion complexity and procedural success rates (80.4 % vs. 81.5 %; p = 0.79), patients with anemia had higher rates of in-hospital complications and one-year mortality (18.1 % vs. 5.0 %; HR = 4.0, p < 0.001)one-year target lesion failure (HR = 1.9; 95 % CI [1.2-2.9]; p = 0.005). Multivariate analysis identified age, heart failure, anemia and multivessel PCI as independent predictors of mortality at one-year, while CKD, and ISR lesion were predictors of TLF at one-year. The severity of anemia was not independently associated with all-cause mortality.
Conclusion:
Pre-procedural anemia is associated with markedly worse in-hospital and long-term outcomes in patients undergoing CTO PCI, despite comparable technical success. These findings highlight anemia as a marker of systemic vulnerability and underscore the need for comprehensive risk stratification and multidisciplinary care in this high-risk population.
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