Prognostic implications of anemia with or without chronic kidney disease in patients undergoing elective percutaneous coronary intervention☆
Introduction
Anemia is a common comorbidity in patients with coronary artery disease (CAD) [1]. Its prevalence increases with disease severity as a consequence of associated disorders such as chronic kidney disease (CKD), iron deficiency, malnutrition and cancer-related blood losses [2]. Anemia may increase the risk of cardiovascular events by inducing myocardial ischemia [3], congestive heart failure [4], or by contributing to high residual platelet activity on clopidogrel [5]. Recent cohort studies have reported worse clinical outcomes among anemic patients undergoing percutaneous coronary intervention (PCI) [6], [7], [8]. However, the hemoglobin (Hb) level that may affect cardiovascular outcomes and whether the presence of CKD influences the outcomes in these patients remain obscure. Moreover, little data is available regarding the impact of anemia on prognosis in patients undergoing elective PCI. In the present study, we investigated the relationship between severity of anemia, CKD, and clinical outcomes in patients who underwent elective PCI, analyzing data from a multicenter registry in Japan.
Section snippets
Study design and patient population
We included the study patients from the CREDO-Kyoto registry cohort-2. The design and patient enrollment of the CREDO-Kyoto registry cohort-2 has been previously described [9]. In brief, the CREDO-Kyoto registry cohort-2 is a physician-initiated non-company sponsored multi-center registry enrolling consecutive patients who underwent first coronary revascularization in 26 centers in Japan between January 2005 and December 2007 (Supplemental Appendix A). Among 15,263 patients enrolled in the
Baseline characteristics
Anemia was observed in 2206 patients (30.2% of the study population) composed of mild anemia (n = 1466, 20.1%) and moderate-to-severe anemia (n = 740, 10.1%) (Table 1). Compared to patients in the no-anemia group, patients in the anemia groups were older, likely to be female, and had more comorbidities such as CKD, hypertension, diabetes mellitus, thrombocytopenia, and malignancy. Cardiovascular complications such as prior myocardial infarction (MI), prior stroke, peripheral vascular disease, heart
Discussion
In this large cohort of 7299 patients undergoing elective PCI, (1) anemia was observed in as many as 2206 patients (30.2% of the entire study population), composed of 1466 patients with mild anemia (20.1%) and 740 patients with moderate-to-severe anemia (10.1%), (2) anemic patients had more comorbidities such as CKD, advanced age, hypertension, diabetes mellitus, malignancy, and cardiovascular complications, (3) both mild and moderate-to-severe anemia were associated with worse long-term
Conclusions
Anemia was significantly associated with worse 3-year clinical outcomes in patients undergoing elective PCI. According to the WHO definition of anemia, even mild anemia was significantly associated with the risk for MACE. Coexisting CKD additively increased the risk for MACE in these patients.
Acknowledgments
This study was supported by the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. We appreciate the support and collaboration of the co-investigators participating in the CREDO-Kyoto PCI/CABG registry cohort-2. We are indebted to the outstanding effort of the clinical research coordinators for data collection. We also thank Tomás Romero, MD, Associate Clinical Professor, University of California, San Diego, for his advice in the review and editing the manuscript.
References (28)
The blood in systemic disorders
Lancet
(2000)- et al.
Impact of anemia on platelet response to clopidogrel in patients undergoing percutaneous coronary stenting
Am J Cardiol
(2012) - et al.
Impact of anemia on outcomes of patients undergoing percutaneous coronary interventions
Am J Cardiol
(2004) - et al.
Revised equations for estimated GFR from serum creatinine in Japan
Am J Kidney Dis
(2009) - et al.
Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial
J Am Coll Cardiol
(2005) - et al.
Anemia is an independent predictor of mortality after percutaneous coronary intervention
J Am Coll Cardiol
(2004) - et al.
Effect of hemoglobin level on long-term all-cause mortality after percutaneous coronary intervention in African-Americans
Am J Cardiol
(2009) - et al.
A secondary analysis of the CHOIR trial shows that comorbid conditions differentially affect outcomes during anemia treatment
Kidney Int
(2010) - et al.
Haemoglobin-related mortality in patients undergoing percutaneous coronary interventions
Eur Heart J
(2003) - et al.
Acute dilutional anemia and critical left anterior descending coronary artery stenosis impairs end organ oxygen delivery
J Trauma
(1996)
Heart failure and anemia: mechanisms and pathophysiology
Heart Fail Rev
Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention
Circulation
The impact of anemia on long-term clinical outcome in patients undergoing revascularization with the unrestricted use of drug-eluting stents
Circ Cardiovasc Interv
Long-term safety and efficacy of sirolimus-eluting stents versus bare-metal stents in real world clinical practice in Japan
Cardiovasc Intervent Ther
Cited by (0)
- ☆
This study was supported by the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan.