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Prognostic Impact of Baseline Anemia on Outcomes After Elective PCI in Men: A US Retrospective Cohort Study
Abdalhakim Shubietah1, Mohamed S Elgendy2, Mohamed Saad Rakab3
1Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
Insights
Preprocedural anemia in men undergoing elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is linked to increased risks of acute kidney injury, major bleeding, and death within 12 months.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Hematology
Background:
- The independent impact of preprocedural anemia on outcomes following elective percutaneous coronary intervention (PCI) in men with stable coronary artery disease (CAD) remains unclear.
- Anemia is a common comorbidity that may influence cardiovascular outcomes.
Purpose of the Study:
- To investigate the independent association between preprocedural anemia and adverse outcomes after elective PCI in men with stable CAD.
- To evaluate the short-term and long-term risks associated with anemia in this patient population.
Main Methods:
- A retrospective cohort study using the TriNetX US Collaborative Network (2016-2024).
- Adult men undergoing first-time elective PCI for stable CAD were compared: those with hemoglobin < 13 g/dL (pre-PCI) versus non-anemic controls.
- Propensity-score matching created balanced cohorts (n=1424). Outcomes (7 days to 12 months) analyzed using Cox models, with adjustments for confounding and multiplicity.
Main Results:
- At 30 days, anemia was associated with higher risks of acute kidney injury (AKI) and major bleeding.
- At 6 and 12 months, anemia was significantly linked to increased risks of AKI, mortality, hospitalization, major bleeding, and transfusion.
- The association with Major Adverse Cardiovascular Events (MACE) was sensitive to multiplicity adjustments, not consistently significant at 12 months.
Conclusions:
- Preprocedural anemia in men undergoing elective PCI for stable CAD is independently associated with significantly higher 12-month risks.
- These risks include acute kidney injury, major bleeding, transfusion, hospitalization, and mortality.
- The findings highlight the importance of addressing anemia in patients undergoing elective PCI.
Background:
It is unclear whether preprocedural anemia independently affects outcomes after elective PCI in men with stable CAD.
Methods:
Using the TriNetX US Collaborative Network, we identified adult men undergoing first-time elective PCI (2016-2024) and compared those with hemoglobin < 13 g/dL (1-7 days pre-PCI) to non-anemic controls. Propensity-score matching produced two balanced cohorts (n = 1424). Outcomes at 7 days, 30 days, 6 months, and 12 months were analyzed with univariate and multivariable Cox models. Residual confounding was assessed with falsification endpoints and E-values, and multiplicity with Bonferroni and Benjamini-Hochberg adjustments.
Results:
After propensity-score matching, 7-day outcomes were similar between groups. At 30 days, anemia was associated with higher risks of AKI (HR 1.92; 95% CI 1.35-2.72) and major bleeding (HR 2.49; 95% CI 1.48-4.19); however, the 30-day association with all-cause hospitalization (HR 1.32; 95% CI 1.05-1.66) did not remain statistically significant after multiplicity adjustment. At 6 months, anemia was linked to higher risks of AKI (HR 2.34; 95% CI 1.84-2.97), mortality (HR 2.63; 95% CI 1.63-4.26), hospitalization (HR 1.56; 95% CI 1.34-1.80), major bleeding (HR 3.28; 95% CI 2.34-4.61), and transfusion (HR 5.47; 95% CI 3.31-9.06); the association with MACE (HR 1.37; 95% CI 1.10-1.70) was sensitive to multiplicity adjustment (significant under false-discovery-rate control but not Bonferroni). At 12 months, anemia remained associated with higher risks of AKI (HR 1.96; 95% CI 1.60-2.41), mortality (HR 1.88; 95% CI 1.31-2.70), hospitalization (HR 1.41; 95% CI 1.23-1.62), major bleeding (HR 2.16; 95% CI 1.66-2.81), and transfusion (HR 3.35; 95% CI 2.31-4.85); the association with MACE (HR 1.26; 95% CI 1.03-1.53) did not persist after multiplicity adjustment. Each 1 g/dL increase in hemoglobin was associated with lower risks of AKI and transfusion in univariate Cox models, with similar directionality after adjustment.
Conclusions:
In men undergoing first-time elective PCI for stable CAD, baseline anemia was associated with higher 12-month risks of AKI, major bleeding, transfusion, hospitalization, and death-especially with recent (≤ 1 year) bleeding or transfusion.
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