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Joseph BC, Sekayan T, Falah N, Barnes RFW, Flood V, De Pablo-Moreno JA, von Drygalski A. Traumatic bleeding and mortality in mice are intensified by iron deficiency anemia and can be rescued with tranexamic acid. Res Pract Thromb Haemost 2024; 8:102543. [PMID: 39286605 PMCID: PMC11403369 DOI: 10.1016/j.rpth.2024.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 09/19/2024] Open
Abstract
Background Clinical evidence suggests that anemia exacerbates traumatic bleeding and worsens outcomes. Objectives To study the influence of iron deficiency anemia on traumatic bleeding, coagulopathy, and mortality. Methods C57BL/6J mice received an iron-deficient diet (8 weeks; ±1 mg intraperitoneal iron dextran 2 weeks before trauma). Control mice received a normal diet. Iron deficiency anemia was confirmed by hematocrit, red cell indices, and liver iron. Mice received saline or tranexamic acid (TXA; 10 mg/kg) just before liver laceration. Blood loss, coagulopathy (activated partial thromboplastin time, factor [F]II, FV, FVIII, FX, and fibrinogen), D-dimer, thrombin-antithrombin complexes, and plasmin-alpha-2-antiplasmin complexes were analyzed at 15 and 60 minutes, and a cytokine panel was performed at 60 minutes and 6 hours after trauma. Survival was monitored for 7 days. Results Compared with nonanemic mice, anemic mice had lower hematocrit and hepatic iron content. Anemic mice experienced higher blood loss compared with nonanemic mice, which was reduced by TXA. Both groups developed traumatic coagulopathy characterized by activated partial thromboplastin time prolongation, thrombin-antithrombin complex formation, and depletion of FV, FVIII, and fibrinogen. TXA corrected the coagulopathy. However, plasmin-alpha-2-antiplasmin complex formation and D-dimers, markers of fibrinolysis, were higher in anemic mice and were not corrected by TXA. Seven-day survival was low in anemic mice, and rescued by TXA, but high in nonanemic mice without additional improvement by TXA. Among cytokines, only interleukin-6 increased, which was prevented by TXA most notably in anemic mice. Conclusion These observations provide first and critical proof-of-principle evidence that anemia accelerates traumatic bleeding and increases mortality, which could be rescued by anemia correction (parenteral iron) or periprocedural TXA.
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Affiliation(s)
- Bilgimol Chumappumkal Joseph
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California, USA
| | - Tro Sekayan
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California, USA
| | - Nicca Falah
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California, USA
| | - Veronica Flood
- Versiti Blood Research Institute, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Juan A De Pablo-Moreno
- Department of Genetic, Physiology and Microbiology, Biology School, Complutense University of Madrid, Madrid, Spain
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, La Jolla, California, USA
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2
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Zhu Z, Zhou X. Association between anaemia and long-term prognosis in patients with non-ST segment elevation myocardial infarction. Acta Cardiol 2024; 79:179-186. [PMID: 38085221 DOI: 10.1080/00015385.2023.2289718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 04/18/2024]
Abstract
BACKGROUND The majority of existing studies examining the association between anaemia and the prognosis of patients with acute coronary syndrome (ACS) have focused on all patients with ACS without further categorisation. As a result, there is a dearth of research specifically exploring the relationship between anaemia and the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). To address this gap, this study aimed to investigate the correlation between anaemia and the long-term prognosis of NSTEMI patients. METHODS This study included 482 NSTEMI patients who underwent percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Chongqing Medical University from September 1, 2016 to May 31, 2022, and the patients were classified into the major adverse cardiovascular events (MACE) group and non-MACEs group according to whether or not they had developed MACE as of February 28, 2023 at follow-up.COX regression analysis was used to assess whether anaemia was an independent factor influencing MACE occurrence in patients with NSTEMI. Receiver operating characteristic (ROC) curve analysis was conducted to determine if haemoglobin levels could enhance the predictive capacity of the Global Registry of Acute Coronary Events (GRACE) score for the prognosis of NSTEMI patients. Haemoglobin levels were categorised into two groups based on the optimal cut-off value and transformed into binary data. The log-rank test was performed to compare the two groups, and a risk function was plotted. RESULTS During a median follow-up period of 31 months, 124 (25.7%) MACE were identified. Univariate and multivariate COX regression analyses revealed that sex, age, smoking history, diabetes, creatinine, erythrocyte count, and haemoglobin level were independent risk factors that significantly influenced survival time. Subsequently, ROC curve analysis was performed to evaluate the predictive accuracy of specific variables. When the cut-off value for the decline ratio of haemoglobin was set at 128.50, the area under the curve (AUC) was determined to be 0.604, with a sensitivity of 0.403 and a specificity of 0.771. Similarly, setting the cut-off value for the reduction ratio of the GRACE score at 141.5 yielded an AUC of 0.700, with a sensitivity of 0.645 and a specificity of 0.709. Furthermore, when the cut-off value for the predicted probability of haemoglobin combined with the GRACE score was 0.270, the AUC was calculated as 0.702, with a sensitivity of 0.677 and a specificity of 0.696. CONCLUSION Haemoglobin levels were identified as an independent factor influencing the survival duration of patients with NSTEMI.
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Affiliation(s)
- Zhulin Zhu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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3
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Sun C, Zhong L, Wu Y, Cao C, Guo D, Liu J, Gong L, Zhang S, Sun J, Yu Y, Tong W, Yang J. Incorporation of Laboratory Test Biomarkers Into Dual Antiplatelet Therapy Score Improves Prediction of Ischemic and Bleeding Events in Post-percutaneous Coronary Intervention Patients. Front Cardiovasc Med 2022; 9:834975. [PMID: 35651911 PMCID: PMC9148992 DOI: 10.3389/fcvm.2022.834975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to examine the performance of the dual antiplatelet therapy (DAPT) score in two retrospective cohorts of post-percutaneous coronary intervention (PCI) patients and to explore whether incorporating additional biomarkers could further improve the predictive power of the DAPT score. In a retrospective derivation cohort of 4,798 PCI patients, the validity of DAPT score for stratifying ischemic/bleeding risks was explored. Then, the association between the baseline status of 54 laboratory test biomarkers and ischemic/bleeding events was revealed while adjusting for the DAPT score. Combinations of individual laboratory test biomarkers that were significantly associated with ischemic/bleeding events were explored to identify the ones that improved discrimination of ischemic and bleeding events when incorporated into DAPT score. Finally, the impact of the combination of biomarkers with DAPT score was validated in an independent retrospective validation cohort of 1,916 PCI patients. Patients with a high DAPT score (DAPT score ≥ 2) had significantly higher risk of ischemic events and significantly lower risk of bleeding than patients with a low DAPT score (DAPT score < 2). Moreover, the addition of aspartate aminotransferase (AST) and red cell distribution width CV (RDW-CV) into the DAPT score further improved discrimination of ischemia and bleeding. Furthermore, the incremental predictive value of AST + RDW-CV maintained with measurements was updated at post-baseline time points. DAPT score successfully stratified the risks of ischemia/bleeding post PCI in the current cohorts. Incorporation of AST + RDW-CV into the DAPT score further improved prediction for both ischemic and bleeding events.
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Affiliation(s)
- Chengming Sun
- Department of Clinical Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Lin Zhong
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yanqiu Wu
- Medical Information Center, Peking University People’s Hospital, Beijing, China
| | - Chengfu Cao
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Danjie Guo
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Jie Liu
- Biochip Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Lei Gong
- Biochip Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shouxin Zhang
- Biochip Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jun Sun
- Biochip Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yingqi Yu
- Gennlife (Beijing) Technology Co., Ltd., Beijing, China
| | - Weiwei Tong
- Gennlife (Beijing) Technology Co., Ltd., Beijing, China
- *Correspondence: Weiwei Tong,
| | - Jun Yang
- Department of Cardiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- Jun Yang,
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Soh RYH, Sia CH, Djohan AH, Lau RH, Ho PY, Neo JWH, Ho JSY, Sim HW, Yeo TC, Tan HC, Chan MYY, Loh JPY. Clinical Characteristics and Long-Term Outcomes of Patients With Differing Haemoglobin Levels Undergoing Semi-Urgent and Elective Percutaneous Coronary Intervention in an Asian Population. Front Cardiovasc Med 2022; 9:687555. [PMID: 35369342 PMCID: PMC8971291 DOI: 10.3389/fcvm.2022.687555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to investigate the impact of anaemia on long-term clinical outcomes in patients who underwent semi-urgent and elective percutaneous coronary intervention (PCI) in an Asian population. Although the effects of anaemia on outcomes in Asian patients are well studied for acute coronary syndrome, its impact on Asian patients undergoing semi-urgent and elective PCI is unclear. Methods This was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from January 1, 2014, to December 31, 2015, at a tertiary academic centre. A total of 1,685 patients were included. They were stratified into three groups: normal (≥12 g/dL), intermediate (10–11.9 g/dL), and low (<10 g/dL) haemoglobin levels. Demographics, risk factors, and end-points including the 5-point major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation), cardiovascular death, and bleeding events were analysed. Results Patients in intermediate and low haemoglobin level groups were older with more comorbidities. Compared to the normal haemoglobin level group, low haemoglobin level group patients were associated with an increased risk of composite endpoints of all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation [adjusted hazard ratio (aHR) 1.89, 95% confidence interval (CI):1.22, 2.92; p = 0.004]. This was driven by the increased risk of target lesions revascularisation observed in the low haemoglobin level group compared to the normal haemoglobin level group (aHR 17.74, 95% CI: 1.74, 180.80; p = 0.015). The patients in the low haemoglobin level group were also associated with a higher risk of bleeding events compared to the normal haemoglobin level group (aHR 7.18, 95% CI: 1.13, 45.40; p = 0.036). Conclusion In our Asian cohort, patients with anaemia undergoing PCI were associated with a higher comorbid burden. Despite adjustments for comorbidities, these patients had higher mortality and worse cardiovascular outcomes following contemporary PCI.
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Affiliation(s)
- Rodney Yu-Hang Soh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
- *Correspondence: Ching-Hui Sia,
| | | | - Rui-Huai Lau
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Pei-Ying Ho
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jonathan Wen-Hui Neo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Jamie Sin-Ying Ho
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hui-Wen Sim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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5
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Akama J, Shimizu T, Ando T, Anzai F, Muto Y, Kimishima Y, Kiko T, Yoshihisa A, Yamaki T, Kunii H, Nakazato K, Ishida T, Takeishi Y. Prognostic Value of the Pattern of Non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS) Bleeding Risk Score for Long-Term Mortality After Percutaneous Coronary Intervention. Int Heart J 2022; 63:15-22. [DOI: 10.1536/ihj.21-440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Joh Akama
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takeshi Shimizu
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takuya Ando
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Fumiya Anzai
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yuuki Muto
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yusuke Kimishima
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University
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Davidsen L, Kragholm KH, Aldahl M, Polcwiartek C, Torp-Pedersen C, Soegaard P, Freeman P. Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina. Open Heart 2020; 7:e001319. [PMID: 33004620 PMCID: PMC7534726 DOI: 10.1136/openhrt-2020-001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group. METHODS From Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia. RESULTS Of 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001). CONCLUSION Anaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.
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Affiliation(s)
- Line Davidsen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
- Department of Cardiology, Regionshospital Nordjylland, Hjørring, Nordjylland, Denmark
| | - Mette Aldahl
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
- Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Peter Soegaard
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Phillip Freeman
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
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7
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Shen JH, Wang HM, Zheng KL, Lu HH, Zhang Q. Correlation of the ORBIT Score With 30-Day Mortality in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2020; 26:1076029620940047. [PMID: 33079594 PMCID: PMC7791435 DOI: 10.1177/1076029620940047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A new scoring system Outcomes Registry for Better Informed Treatment (ORBIT) score is used to assess the bleeding risk in anticoagulated patients with atrial fibrillation (AF). Our aim is to investigate the possible correlations of the ORBIT score with 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 639 patients with STEMI were enrolled in this study. The ORBIT, HAS-BLED, and TIMI scores were recorded during admission. After 30 days' follow-up, 639 patients were divided into 2 groups: the survival group and the nonsurvival group. Different clinical parameters were compared. The predictive values of the ORBIT, HAS-BLED, and TIMI scores for 30-day mortality were assessed from receiver operating characteristic (ROC) analyses. The univariate and multivariate Cox proportional hazards analyses were applied to evaluate the relationships between variables and 30-day mortality. Sixty-seven deaths occurred after a 30-day follow-up. The ORBIT, HAS-BLED, and TIMI scores in the death group were higher than those in the survival group (P < .05). The areas under the ROC curve for the ORBIT, HAS-BLED, and TIMI scores to predict the occurrence of 30-day mortality were 0.811 (95% CI: 0.779-0.841, P < .0001), 0.717 (95% CI: 0.680-0.752, P < .0001), and 0.844 (95% CI: 0.813-0.871, P < .0001), respectively. In multivariate Cox proportional hazards modeling, the high ORBIT score was positively associated with 30-day mortality (hazard ratio: 1.309, 95% CI: 1.101-1.556, P = .013) after adjustment. A graded relation is found in the elevated ORBIT score and 30-day mortality in patients with STEMI. Thus, the ORBIT score can be an independent predictor of 30-day mortality in patients with STEMI.
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Affiliation(s)
- Jun-Hua Shen
- Emergency Department, The Second Affiliated Hospital of Nantong University, China
| | - Hui-Min Wang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Kou-Long Zheng
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Hui-He Lu
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
| | - Qing Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University, China
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8
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Nagao K, Watanabe H, Morimoto T, Inada T, Hayashi F, Nakagawa Y, Furukawa Y, Kadota K, Akasaka T, Natsuaki M, Kozuma K, Tanabe K, Morino Y, Shiomi H, Kimura T. Prognostic Impact of Baseline Hemoglobin Levels on Long-Term Thrombotic and Bleeding Events After Percutaneous Coronary Interventions. J Am Heart Assoc 2019; 8:e013703. [PMID: 31701786 PMCID: PMC6915278 DOI: 10.1161/jaha.119.013703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Association of baseline hemoglobin levels with long‐term adverse events after percutaneous coronary interventions has not been yet thoroughly defined. We aimed to assess the clinical impact of baseline hemoglobin on long‐term ischemic and bleeding risk after percutaneous coronary intervention. Methods and Results Using the pooled individual patient‐level data from the 3 percutaneous coronary intervention studies, we categorized 19 288 patients into 4 groups: high‐normal hemoglobin (≥14.0 g/dL; n=7555), low‐normal hemoglobin (13.0–13.9 g/dL in men and 12.0–13.9 g/dL in women; n=5303), mild anemia (11.0–12.9 g/dL in men and 11.0–11.9 g/dL in women; n=4117), and moderate/severe anemia (<11.0 g/dL; n=2313). Median follow‐up duration was 3 years. Low‐normal hemoglobin, mild anemia, and moderate/severe anemia correlated with significant excess risk relative to high‐normal hemoglobin for GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Trial) moderate/severe bleeding, with adjusted hazard ratios of 1.22 (95% CI, 1.04–1.44), 1.73 (95% CI, 1.47–2.04), and 2.31 (95% CI, 1.92–2.78), respectively. Moderate/severe anemia also correlated with significant excess risk relative to high‐normal hemoglobin for the ischemic composite end point of myocardial infarction/ischemic stroke (adjusted hazard ratio, 1.33; 95% CI, 1.11–1.60), whereas low‐normal hemoglobin and mild anemia did not. However, the excess risk of low‐normal hemoglobin, mild anemia, and moderate/severe anemia relative to high‐normal hemoglobin remained significant for ischemic stroke and for mortality. Conclusions Decreasing baseline hemoglobin correlated with incrementally higher long‐term risk for major bleeding, ischemic stroke, and mortality after percutaneous coronary intervention. Even within normal range, lower baseline hemoglobin level correlated with higher ischemic and bleeding risk.
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Affiliation(s)
- Kazuya Nagao
- Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan
| | - Fujio Hayashi
- Department of Cardiovascular Center Osaka Red Cross Hospital Osaka Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular and Respiratory Medicine Shiga University of Medical Science Otsu Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan
| | - Kazushige Kadota
- Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan
| | | | - Ken Kozuma
- Department of Cardiology Teikyo University Hospital Tokyo Japan
| | - Kengo Tanabe
- Department of Cardiology Mitsui Memorial Hospital Tokyo Japan
| | - Yoshihiro Morino
- Department of Cardiology Iwate University Hospital Morioka Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
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9
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Wester A, Attar R, Mohammad MA, Andell P, Hofmann R, Jensen J, Szummer K, Erlinge D, Koul S. Impact of Baseline Anemia in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: A Prespecified Analysis From the VALIDATE-SWEDEHEART Trial. J Am Heart Assoc 2019; 8:e012741. [PMID: 31387441 PMCID: PMC6759912 DOI: 10.1161/jaha.119.012741] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The impact of baseline anemia in a contemporary acute coronary syndrome (ACS) population undergoing percutaneous coronary intervention in the era of predominant radial artery access, potent P2Y12 inhibition, and rare use of glycoprotein IIb/IIIa inhibitors has not been adequately studied. Methods and Results ACS patients who underwent percutaneous coronary intervention between 2014 and 2016 in the VALIDATE‐SWEDEHEART (Bivalirudin Versus Heparin in ST‐Segment and Non–ST‐Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies Registry) trial without missing values for hemoglobin were included (n=5482). Mortality, myocardial reinfarction, and major bleeding at 180 days were assessed using Cox regression models and propensity score matching. All studied comorbidities were more common in ACS patients who had anemia (n=792). ACS patients with anemia had higher rates of 180‐day mortality (6.9% versus 2.1%; hazard ratio, 1.9; 95% CI, 1.3–2.7; P<0.001), myocardial reinfarction (4.3% versus 1.9%; hazard ratio, 1.7; 95% CI, 1.1–2.7; P=0.013), and major bleeding (13.4% versus 8.2%; hazard ratio, 1.3; 95% CI, 1.0–1.6; P=0.041). The results were most evident in patients with a hemoglobin value <100 g/L, who had a nearly 10 times higher mortality rate. Conclusions Baseline anemia in ACS patients undergoing percutaneous coronary intervention, treated according to current practice including routine radial artery access, constitutes a high‐risk feature for both ischemic events, bleeding events, and mortality. A multidisciplinary approach is warranted to maximize benefit and minimize patient risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02311231.
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Affiliation(s)
- Axel Wester
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Rubina Attar
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden.,Department of Cardiology Clinical Medicine Aalborg University Aalborg Denmark
| | - Moman Aladdin Mohammad
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Pontus Andell
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden.,Unit of Cardiology Department of Medicine Karolinska Institute Stockholm Sweden.,Heart and Vascular Division Karolinska University Hospital Stockholm Sweden
| | - Robin Hofmann
- Division of Cardiology Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Jens Jensen
- Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden.,Unit of Cardiology Capio S:t Göran Hospital Stockholm Sweden
| | - Karolina Szummer
- Unit of Cardiology Department of Medicine Karolinska Institute Stockholm Sweden.,Heart and Vascular Division Karolinska University Hospital Stockholm Sweden
| | - David Erlinge
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
| | - Sasha Koul
- Department of Cardiology Clinical Sciences Lund University Skåne University Hospital Lund Sweden
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Jiang L, Gao Z, Song Y, Xu J, Tang X, Wang H, Liu R, Jiang P, Xu B, Yuan J. Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data. J Interv Cardiol 2018; 31:826-833. [PMID: 30467893 DOI: 10.1111/joic.12570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the impact of anemia on 2-year outcomes in patients undergoing contemporary percutaneous coronary intervention (PCI). BACKGROUND Whether anemia is an independent predictor of adverse outcomes after PCI is under debate. METHODS A total of 10 717 consecutive patients who underwent PCI with available hemoglobin values at Fuwai Hospital were collected. Clinical outcomes were compared between patients with and without anemia both before and after PCI procedure. RESULTS Totally, 1348 (12.5%) and 3111 (29.0%) patients presented with pre- and post-PCI anemia according to World Health Organization criteria (hemoglobin level <120 g/L for women or <130 g/L for men), respectively. Anemic patients presented with more baseline clinical risks and more extensive coronary disease than those without anemia. During 2-year follow-up, patients with pre-PCI anemia had higher incidence of bleeding and stroke than those without pre-PCI anemia. Patients with post-PCI anemia experienced higher incidence of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), bleeding, and major adverse cardiovascular events (MACE) than those without post-PCI anemia. Survival analyses were performed using multivariable Cox proportional hazards models both before and after propensity score matching. Pre-PCI anemia was not an independent risk factor of any adverse clinical events. Post-PCI anemia was not an independent risk factor of all-cause death, but was an independent risk factor of MI, TVR, and MACE. CONCLUSIONS Pre-PCI anemia was not an independent risk factor of any adverse clinical events, while post-PCI anemia had a predictable value of MI, TVR, and MACE after PCI.
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Affiliation(s)
- Lin Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huanhuan Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ru Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ping Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Al-Hijji MA, Gulati R, Lennon RJ, Bell M, El Sabbagh A, Park JY, Slusser J, Sandhu GS, Reeder GS, Rihal CS, Singh M. Outcomes of Percutaneous Coronary Interventions in Patients With Anemia Presenting With Acute Coronary Syndrome. Mayo Clin Proc 2018; 93:1448-1461. [PMID: 30286831 DOI: 10.1016/j.mayocp.2018.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the influence of anemia on long-term outcomes of patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS The study included 5668 consecutive unique patients with acute coronary syndrome who underwent PCI at Mayo Clinic from January 1, 2004, through December 31, 2014. The patients were stratified on the basis of the presence (hemoglobin [Hgb] level, <13 g/dL in men and <12 g/dL in women) and severity (moderate to severe Hgb level, <11 g/dL in men and women) of pre-PCI anemia and compared with patients without anemia. The primary outcomes were in-hospital and long-term all-cause mortality after balancing baseline comorbidities using the inverse propensity weighting method. RESULTS Unadjusted all-cause in-hospital mortality (4.6% [84 of 1831] vs 2.0% [75 of 3837]) and 5-year follow-up mortality (44.4% [509] vs 15.4% [323]) were higher in patients with anemia than in those without anemia (P<.001 for both). After applying inverse propensity weighting analysis, the all-cause in-hospital mortality (2.0% [37] vs 2.0% [75]; P=.85) and 5-year mortality (17.8% [203] vs 15.4% [323]; P=.05) were not significantly different between patients with and without anemia; however, there were higher rates of all-cause 5-year mortality in patients with moderate to severe anemia (22.3% [113] vs 15.4% [323]; P<.001) compared with patients without anemia. The trend in 5-year mortality was driven by increased noncardiac mortality in patients with anemia (10.2% [91] vs 7.1% [148]; P=.04) and moderate to severe anemia (10.4% [52] vs 7.1% [148]; P=.006) when compared with nonanemic patients. CONCLUSION After accounting for differences in risk profiles of anemic and nonanemic patients, anemia appeared to be an independent risk factor for increased long-term all-cause and noncardiac mortality.
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Affiliation(s)
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Jae Yoon Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joshua Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Guy S Reeder
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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12
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Influence of Age and Gender on Clinical Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ 2017; 26:554-565. [DOI: 10.1016/j.hlc.2016.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022]
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13
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Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2016; 118:610-20. [PMID: 27342283 DOI: 10.1016/j.amjcard.2016.05.059] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 12/21/2022]
Abstract
Anemia is common in patients undergoing percutaneous coronary intervention (PCI), and current guidelines fail to offer recommendations for its management. This review aims to examine the relation between baseline anemia and mortality, major adverse cardiovascular events (MACE), and major bleeding in patients undergoing PCI. We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse outcomes in anemic and nonanemic patients who underwent PCI. Data were collected on study design, participant characteristics, definition of anemia, follow-up, and adverse outcomes. Random effects meta-analysis of risk ratios was performed using inverse variance method. A total of 44 studies were included in the review with 230,795 participants. The prevalence of baseline anemia was 26,514 of 170,914 (16%). There was an elevated risk of mortality and MACE with anemia compared with no anemia-pooled risk ratio (RR) 2.39 (2.02 to 2.83), p <0.001 and RR 1.51 (1.34 to 1.71), p <0.001, respectively. The risk of myocardial infarction and bleeding with anemia compared with no anemia was elevated, pooled RR 1.33 (1.07 to 1.65), p = 0.01 and RR 1.97 (1.03 to 3.77), p <0.001, respectively. The risk of mortality per unit incremental decrease in hemoglobin (g/dl) was RR 1.19 (1.09 to 1.30), p <0.001 and the risk of mortality, MACE, and reinfarction per 1 unit incremental decrease in hematocrit (%) was RR 1.07 (1.05 to 1.10), p = 0.04, RR 1.09 (1.08 to 1.10) and RR 1.06 (1.03 to 1.10), respectively. The prevalence of anemia in contemporary cohorts of patients undergoing PCI is significant and is associated with significant increases in postprocedural mortality, MACE, reinfarction, and bleeding. The optimal strategy for the management of anemia in such patients remains uncertain.
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Wang X, Qiu M, Qi J, Li J, Wang H, Li Y, Han Y. Impact of anemia on long-term ischemic events and bleeding events in patients undergoing percutaneous coronary intervention: a system review and meta-analysis. J Thorac Dis 2015; 7:2041-52. [PMID: 26716044 DOI: 10.3978/j.issn.2072-1439.2015.11.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data focused on the ischemic events and bleeding events are still limited. We systematically reviewed the current available literature to investigate whether anemia increase incidence of long-term ischemic events and long-term bleeding events in patients undergoing PCI. METHODS PubMed and Embase were searched for case-control studies regarding the impact of anemia on long-term outcomes in patients undergoing percutaneous coronary intervention (PCI). The primary outcome was long-term ischemic events and long-term bleeding events. Mantel-Haenszel method with random effects model or fixed effects model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Seventeen studies involving 68,528 patients (17,123 anemic patients and 51,405 non-anemic patients) were included. Pooled analysis suggested that anemic patients were at higher risk for long-term composite ischemic events (OR: 1.95, 95% CI, 1.21-3.14, P<0.01, I(2)=84%), long-term reinfarction (0R: 1.63, 95% CI, 1.16-2.28, P<0.01, I(2)=82%) and long-term bleeding events (OR: 2.89, 95% CI, 1.68-4.98, P<0.001, I(2)=89%). Anemia was also associated with long-term mortality (OR: 3.20, 95% CI, 2.72-3.75, P<0.01, I(2)=65%) and major adverse cardiac events (MACE) (OR: 2.06, 95% CI, 1.48-2.86, P<0.01, I(2)=91%). CONCLUSIONS Anemic patients undergoing PCI are at higher risk for both long-term ischemic events and bleeding events, and also at higher risk for long-term mortality and MACE. There's a need for further clarification and consistency regarding dosage, timing and duration of antithrombotic therapy for the prevention of ischemic events and bleeding events in anemic patients.
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Affiliation(s)
- Xiaoyan Wang
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Miaohan Qiu
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jing Qi
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Jing Li
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Heyang Wang
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yi Li
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
| | - Yaling Han
- 1 Graduate school, Dalian Medical University, Dalian 116044, China ; 2 Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110016, China
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Impact of Anemia and Dual Antiplatelet Therapy on Mortality in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents. Sci Rep 2015; 5:17213. [PMID: 26601689 PMCID: PMC4658638 DOI: 10.1038/srep17213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/09/2015] [Indexed: 01/21/2023] Open
Abstract
The objective was to assess the impact of baseline anemia on all-cause mortality and whether 12-month dual antiplatelet therapy (DAPT) affects 1-year mortality linked to anemia in patients after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). 4109 enrolled patients divided into three groups based on their pre-procedural hemoglobin (Hb) level: Hb < 100 mg/L represented moderate-severe anemia; 100 mg/L ≤ Hb < 120 mg/L for women and 100 mg/L ≤ Hb < 130 mg/L for men represented mild anemia; Hb ≥ 20 mg/L for women and Hb ≥ 130 mg/L for men represented no anemia. DAPT medications were prescribed when patients were discharged. There were significant differences in 30-day and 1-year mortality between moderate-severe anemia and no anemia patients (HR 8.05, 95% CI 1.46 to 44.33, P = 0.017; HR 3.93, 95% CI 1.11 to 13.98, P = 0.034), and in long-term mortality between anemia and no anemia groups (HR 1.82, 95% CI 1.17 to 2.83, P = 0.008 for mild anemia; HR 3.19,95% CI 1.29 to 7.86, P = 0.012 for moderate-severe anemia). There was not significant interaction between 12-month DAPT and anemia on mortality in anemic patients (P for interaction > 0.05). Anemia shows association with increased all-cause mortality in patients undergoing PCI. Twelve-month DAPT does not show synergy with anemia to increase the risk of all-cause 1-year mortality in anemic patients after PCI.
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Kwok CS, Sherwood MW, Watson SM, Nasir SB, Sperrin M, Nolan J, Kinnaird T, Kiatchoosakun S, Ludman PF, de Belder MA, Rao SV, Mamas MA. Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: a systematic review and meta-analysis. JACC Cardiovasc Interv 2015; 8:436-446. [PMID: 25703883 DOI: 10.1016/j.jcin.2014.09.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/15/2014] [Accepted: 09/24/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study sought to define the prevalence and prognostic impact of blood transfusions in contemporary percutaneous coronary intervention (PCI) practice. BACKGROUND Although the presence of anemia is associated with adverse outcomes in patients undergoing PCI, the optimal use of blood products in patients undergoing PCI remains controversial. METHODS A search of EMBASE and MEDLINE was conducted to identify PCI studies that evaluated blood transfusions and their association with major adverse cardiac events (MACE) and mortality. Two independent reviewers screened the studies for inclusion, and data were extracted from relevant studies. Random effects meta-analysis was used to estimate the risk of adverse outcomes with blood transfusions. Statistical heterogeneity was assessed by considering the I(2) statistic. RESULTS Nineteen studies that included 2,258,711 patients with more than 54,000 transfusion events were identified (prevalence of blood transfusion 2.3%). Crude mortality rate was 6,435 of 50,979 (12.6%, 8 studies) in patients who received a blood transfusion and 27,061 of 2,266,111 (1.2%, 8 studies) in the remaining patients. Crude MACE rates were 17.4% (8,439 of 48,518) in patients who had a blood transfusion and 3.1% (68,062 of 2,212,730) in the remaining cohort. Meta-analysis demonstrated that blood transfusion was independently associated with an increase in mortality (odds ratio: 3.02, 95% confidence interval: 2.16 to 4.21, I(2) = 91%) and MACE (odds ratio: 3.15, 95% confidence interval: 2.59 to 3.82, I(2) = 81%). Similar observations were recorded in studies that adjusted for baseline hematocrit, anemia, and bleeding. CONCLUSIONS Blood transfusion is independently associated with increased risk of mortality and MACE events. Clinicians should minimize the risk for periprocedural transfusion by using available bleeding-avoidance strategies and avoiding liberal transfusion practices.
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Affiliation(s)
- Chun Shing Kwok
- Cardiovascular Institute, University of Manchester, Manchester, United Kingdom
| | | | - Sarah M Watson
- Department of Gastroenterology, Royal Bolton Hospital, Farnworth, United Kingdom
| | - Samina B Nasir
- Department of Gastroenterology, Royal Bolton Hospital, Farnworth, United Kingdom
| | - Matt Sperrin
- Institute of Population Health, University of Manchester, United Kingdom
| | - Jim Nolan
- Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Mark A de Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
| | - Mamas A Mamas
- Cardiovascular Institute, University of Manchester, Manchester, United Kingdom.
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17
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Hosseini SK, Ansari MJA, Lotfi Tokaldany M, Sharafi A, Hakki Kazazi E, Poorhosseini H. Association between preprocedural hemoglobin level and 1-year outcome of elective percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2014; 15:331-5. [PMID: 23422885 DOI: 10.2459/jcm.0b013e32835ec938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To evaluate the association between the preprocedural hemoglobin (Hb) level and 1 year major adverse cardiac event (MACE) in patients undergoing percutaneous coronary intervention (PCI). METHODS A total of 2819 patients (mean age 56.61 ± 10.37 years, 69% male) with available preprocedural Hb levels were included. Patients were followed up for 12 months. MACE included cardiac death, myocardial infarction (MI), target vessel revascularization and target lesion revascularization. MACE was compared across the different levels of Hb in nonanemic, mild, moderate, and severe anemia subgroups. RESULTS The preprocedural mean Hb level was 13.56 ± 1.67 g/dl. Anemic patients were older, more frequently women, and less likely to be cigarette smokers compared to the nonanemic group. Patients with Hb less than 10 mg/dl had the highest proportion of renal failure (56.7%) compared to 40.1% in moderate, 34.6% in mild, and 22.7% in nonanemic groups. In-hospital MI and death occurred in 8 (0.3%) and 2 (0.1%) of the nonanemic group, respectively, and 1 (0.3%) patient with mild anemia experienced MI. After 12 months the rate of total MACE was 3.4% in all the patients. After adjustment for age, sex, interaction between sex, and Hb level, smoking, hypertension, diabetes mellitus, and creatinine clearance, only severe anemia with Hb below 10 g/dl was associated with an increased risk of MACE (hazard ratio 4.623; 95% confidence interval 1.642-13.021; P = 0.004). CONCLUSION The impact of anemia on the 12-month MACE was more prominent in patients with Hb below 10 mg/dl. Therefore, in patients with severe anemia listed for PCI, this level of Hb should be considered as a precaution.
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Affiliation(s)
- Seyed Kianoosh Hosseini
- aTehran Heart Center, Interventional Cardiology Department,Tehran University of Medical Sciences bTehran Heart Center, Research Department, Tehran University of Medical Sciences, Tehran, Iran
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Kunadian V, Mehran R, Lincoff AM, Feit F, Manoukian SV, Hamon M, Cox DA, Dangas GD, Stone GW. Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol 2014; 114:1823-9. [PMID: 25438908 DOI: 10.1016/j.amjcard.2014.09.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/14/2014] [Accepted: 09/14/2014] [Indexed: 11/25/2022]
Abstract
There are limited data on the impact of anemia on clinical outcomes in unstable angina and non-ST-segment elevation myocardial infarction treated with an early invasive strategy. We sought to determine the short- and long-term clinical events among patients with and without anemia enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Anemia was defined as baseline hemoglobin of <13 g/dl for men and <12 g/dl for women. The primary end points were composite ischemia (death, myocardial infarction, or unplanned revascularization for ischemia) and major bleeding assessed in-hospital, at 1 month, and at 1 year. Among the 13,819 patients in the ACUITY trial, information regarding anemia was available in 13,032 (94.3%), 2,199 of whom (16.9%) had anemia. Patients with anemia compared with those without anemia had significantly increased adverse event rates in-hospital (composite ischemia 6.6% vs 4.8%, p = 0.0004; major bleeding 7.3% vs 3.3%, p <0.0001), at 1 month (composite ischemia 10% vs 7.2%, p <0.0001, major bleeding 8.8% vs 3.9%, p <0.0001), and 1 year (composite ischemia 21.7% vs 15.3%, p <0.0001). Anemia was an independent predictor of death at 1 year (hazard ratio 1.77, 95% confidence interval [CI] 1.29 to 2.44, p = 0.0005). Composite ischemia was significantly more common among patients who developed in-hospital non-coronary artery bypass surgery major bleeding compared with those who did not (anemic patients 1-year relative risk 2.19, 95% CI 1.67 to 2.88, p <0.0001; nonanemic patients relative risk 2.16, 95% CI 1.76 to 2.65, p <0.0001). In conclusion, in the ACUITY trial, baseline anemia was strongly associated with adverse early and late clinical events, especially in those who developed major bleeding.
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Ten Y, Devlin G. Bivalirudin in acute coronary syndromes and percutaneous coronary intervention: should we use it? Heart Lung Circ 2013; 22:793-800. [PMID: 23916503 DOI: 10.1016/j.hlc.2013.05.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
Major bleeding remains a major risk factor for percutaneous coronary intervention of acute coronary syndromes and is associated with higher morbidity, mortality, prolonged hospital stay and costs. With the recognition that bleeding is an important factor in patient outcomes, the prevention of bleeding has become as important a goal as the prevention of ischaemia. The direct thrombin inhibitor bivalirudin has been shown to reduce ischaemia and importantly, is associated with less bleeding. In this article we review the evidence base that supports the use of bivalirudin across all spectrums of coronary syndromes and percutaneous coronary intervention. An algorithm for the use of bivalirudin in high risk subgroups and coronary syndromes is suggested.
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Affiliation(s)
- Yuli Ten
- Hollywood Hospital, Cardiology, Nedlands, WA 6009, Australia.
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20
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Frequency of and risk factors for complications after liver radiofrequency ablation under CT fluoroscopic guidance in 1500 sessions: single-center experience. AJR Am J Roentgenol 2013; 200:658-64. [PMID: 23436859 DOI: 10.2214/ajr.12.8691] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this article is to retrospectively evaluate the frequency of and risk factors for complications after liver radiofrequency ablation (RFA). MATERIALS AND METHODS This was a retrospective study of 656 patients (with 1755 liver tumors) who underwent 1500 CT fluoroscopy-guided liver RFA sessions. Of those patients, 501 had primary liver tumor and 155 had liver metastases. Mortality and treatment-related complications were documented. Complications were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0). Major complications were defined as grade 3 or higher adverse events. Factors affecting frequent complications with a frequency of 1% or more were detected using multivariate analysis. RESULTS Two deaths (0.1% [2/1500]) occurred. One patient died of liver failure subsequent to hemorrhage, and the other died of liver failure. The major complication rate was 2.8% (42/1500). The most frequent major complication was hemorrhage (1.1% [16/1500]). The absence of arterial embolization before RFA (p < 0.01), low hemoglobin level (p < 0.04), and elevated serum creatinine level (p < 0.04) were identified as significant risk factors for major hemorrhage. The minor complication rate was 17.1% (257/1500). Pneumothorax (7.7% [116/1500]) was the most frequent minor complication, followed by hemorrhage (7.0% [105/1500]). A transthoracic approach (p < 0.01) and subphrenic tumor location (p < 0.01) were significant risk factors for pneumothorax, and the use of a cluster needle (p < 0.02) and multiple tumors (p < 0.01) were significant risk factors for minor hemorrhage. CONCLUSION CT fluoroscopy-guided RFA is a safe procedure with an acceptably low rate of major complications for liver tumor treatment. Factors identified in this study will help to stratify high-risk patients.
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Bagur R, Rinfret S. Transradial Approach for Chronic Total Occlusion Percutaneous Coronary Intervention. Interv Cardiol Clin 2012; 1:355-363. [PMID: 28582021 DOI: 10.1016/j.iccl.2012.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Over the last two decades, the transradial approach has gained an important role in interventional cardiology. A large body of evidence exists supporting the safety and feasibility of the transradial approach in a broad spectrum of patients and settings. In addition, the transradial approach has been applied with good results for chronic total occlusion (CTO) recanalization. This article provides an overview of basic principles and techniques required to perform successful transradial CTO percutaneous coronary intervention.
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Affiliation(s)
- Rodrigo Bagur
- Interventional Cardiology Laboratories, Quebec Heart & Lung Institute-Laval University, 2725 Chemin Sainte-Foy, G1V 4G5, Québec (Québec), Canada
| | - Stéphane Rinfret
- Interventional Cardiology Laboratories, Quebec Heart & Lung Institute-Laval University, 2725 Chemin Sainte-Foy, G1V 4G5, Québec (Québec), Canada.
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Timóteo AT, Hamad H, Miranda F, Santos N, Oliveira JA, Ferreira ML, Ferreira RC. Can the presence of anemia on admission improve the predictive value of the GRACE risk score for short- and medium-term mortality after acute coronary syndrome? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2011.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Biguzzi E, Franchi F, Ambrogi F, Ibrahim B, Bucciarelli P, Acaia B, Radaelli T, Biganzoli E, Mannucci PM. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res 2012; 129:e1-7. [DOI: 10.1016/j.thromres.2011.09.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/18/2011] [Accepted: 09/14/2011] [Indexed: 11/15/2022]
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Timóteo AT, Hamad H, Miranda F, Santos N, Oliveira JA, Ferreira ML, Ferreira RC. [Can the presence of anemia on admission improve the predictive value of the GRACE risk score for short- and medium-term mortality after acute coronary syndrome?]. Rev Port Cardiol 2012; 31:279-85. [PMID: 22440054 DOI: 10.1016/j.repc.2011.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 12/15/2011] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal.
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SARDI GABRIELL, MALUENDA GABRIEL, TORGUSON REBECCA, XUE ZHENYI, SUDDATH WILLIAMO, KENT KENNETHM, LINDSAY JOSEPH, SATLER LOWELLF, PICHARD AUGUSTOD, WAKSMAN RON. Impact of Diabetes Mellitus on Long-term Clinical Outcomes of Patients on Chronic Hemodialysis after Percutaneous Coronary Intervention. J Interv Cardiol 2011; 25:147-55. [DOI: 10.1111/j.1540-8183.2011.00682.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Six-month mortality and cardiac catheterization in non-ST-segment elevation myocardial infarction patients with anemia. Coron Artery Dis 2011; 22:317-23. [PMID: 21738102 DOI: 10.1097/mca.0b013e3283471fb1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown how anemia influences the invasive management of patients with non-ST-segment elevation myocardial infarction (NSTEMI) and associated mortality. We investigated whether receipt of cardiac catheterization relates to 6-month death rates among patients with different severity of anemia. METHODS We used data from the population-based Worcester Heart Attack Study, which included 2634 patients hospitalized with confirmed NSTEMI, from three percutaneous coronary intervention-capable medical centers in the Worcester (Massachusetts, U.S.A.) metropolitan area, during five biennial periods between 1997 and 2005. Severity of anemia was categorized using admission hematocrit levels: less than or equal to 30.0% (moderate-to-severe anemia), 30.1-39.0% (mild anemia), and more than 39.0% (no anemia). Propensity matching and conditional logistic regression adjusting for hospital use of aspirin, heparin, and plavix compared 6-month postadmission all-cause mortality rates in relation to cardiac catheterization during NSTEMI hospitalization. RESULTS Compared with patients without anemia, patients with anemia were less likely to undergo cardiac catheterization {adjusted odds ratio (AOR) 0.79 [95% confidence interval (CI): 0.67-0.95] for mild anemia and 0.45 (95% CI: 0.42-0.49) for moderate-to-severe anemia}. After propensity matching, cardiac catheterization was associated with lower 6-month death rates only in patients without anemia [AOR 0.26 (95% CI: 0.09-0.79)] but not in patients with mild anemia [AOR 0.55 (95% CI: 0.25-1.23)]. The small number of patients rendered data inconclusive for patients with moderate-to-severe anemia. CONCLUSION Anemia at the time of hospitalization for NSTEMI was associated with lower utilization of cardiac catheterization. However, cardiac catheterization use was associated with a decreased risk of dying at 6 months after hospital admission only in patients without anemia.
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Incidence, Prognostic Impact, and Influence of Antithrombotic Therapy on Access and Nonaccess Site Bleeding in Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2011; 4:191-7. [DOI: 10.1016/j.jcin.2010.10.011] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/02/2010] [Accepted: 10/21/2010] [Indexed: 11/20/2022]
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Bertrand OF, Larose É, Rodés-Cabau J, Rinfret S, Déry JP, Bagur R, Gleeton O, Nguyen CM, Proulx G, De Larochellière R, Poirier P, Costerousse O, Roy L. Incidence, range, and clinical effect of hemoglobin changes within 24 hours after transradial coronary stenting. Am J Cardiol 2010; 106:155-61. [PMID: 20598996 DOI: 10.1016/j.amjcard.2010.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 03/04/2010] [Accepted: 03/04/2010] [Indexed: 11/24/2022]
Abstract
Anemia and major bleeding are independent predictors of outcomes after acute coronary syndromes and percutaneous coronary intervention (PCI). Although the transradial approach reduces the incidence of bleeding, the hemoglobin changes after transradial PCI have not been defined. We serially assessed the hemoglobin values before and after transradial PCI and evaluated the effect of hemoglobin changes on outcomes. In the EArly Discharge After Transradial Stenting of CoronarY Arteries (EASY) trial, 1,348 patients underwent transradial PCI. All patients received aspirin, clopidogrel, and a bolus of abciximab before PCI. The hemoglobin values were assessed immediately before and 4 to 6 hours and 12 to 24 hours after PCI. The major adverse cardiac events (death, myocardial infarction, and target vessel revascularization) were assessed < or =3 years after PCI. According to the World Health Organization classification, 206 patients (15%) had anemia before PCI and 410 (30%) developed anemia within 24 hours after PCI. A mean hemoglobin decrease of 0.6 +/- 1.0 g/dl occurred within 24 hours after PCI. At 30 days, the major adverse cardiac events were significantly increased when the hemoglobin decrease within 24 hours after PCI was >3 g/dl (p = 0.0002). Patients with anemia within 24 hours after PCI had significantly more major adverse cardiac events at 30 days, 6 months, 1 year, and 3 years than patients without anemia (log-rank p = 0.0044). After adjustment for differences in the baseline characteristics, anemia within 24 hours after PCI remained an independent predictor of major averse cardiac events at 3 years (hazard ratio 1.30, 95% confidence interval 1.01 to 1.67, p = 0.045). In conclusion, within 24 hours after transradial PCI with maximal antiplatelet therapy, only a mild hemoglobin decrease was observed. The choice of a hemoglobin decrease >3 g/dl after PCI as a cutoff value for current definitions of major bleeding in modern PCI trials appears reasonable. Measures to prevent anemia and blood loss during PCI remain to be further studied.
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Impact of anemia on clinical outcomes of patients with ST-segment elevation myocardial infarction in relation to gender and adjunctive antithrombotic therapy (from the HORIZONS-AMI trial). Am J Cardiol 2010; 105:1385-94. [PMID: 20451683 DOI: 10.1016/j.amjcard.2010.01.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 11/20/2022]
Abstract
The aim of this study was to assess the impact of baseline anemia on the outcomes of patients with ST elevation myocardial infarctions who underwent primary percutaneous coronary intervention in relation to contemporary adjunctive antithrombotic therapy and gender. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients were randomized to bivalirudin alone or to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor before primary percutaneous coronary intervention. Outcomes were assessed at 30 days and 1 year according to anemia and gender. Baseline anemia was present in 331 of 3,153 patients (10.5%). Patients with versus without baseline anemia had a more than twofold increase in major bleeding at 30 days (13.5% vs 6.7%, p <0.0001) and at 1 year (14.8% vs 7.2%, p <0.0001), an association that on multivariate analysis was independent of gender. Mortality was significantly higher in men with versus without baseline anemia (4.6% vs 1.8% at 30 days, p = 0.003; 8.9% vs 3.0% at 1 year, p <0.0001) but not in women (5.3% vs 3.6% at 30 days, p = 0.42; 7.5% vs 5.9% at 1 year, p = 0.54). On multivariate analysis, anemia independently predicted 1-year all-cause mortality in men but not in women. Bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor resulted in twofold lower rates of all-cause and cardiac mortality and major bleeding in patients without but not in those with baseline anemia. In conclusion, baseline anemia was associated with increased major bleeding and death in patients with ST elevation myocardial infarctions who underwent primary PCI but was a stronger predictor of early and late mortality in men than in women. Paradoxically, in this post hoc analysis, the reductions in major bleeding and mortality in ST elevation myocardial infarction afforded by bivalirudin occurred primarily in patients without baseline anemia.
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Dauerman HL, Bhatt DL, Gretler DD, French PA, Smyth SS, Becker RC. Bridging the gap between clinical trials of antiplatelet therapies and applications among elderly patients. Am Heart J 2010; 159:508-517.e1. [PMID: 20362707 DOI: 10.1016/j.ahj.2010.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 01/15/2010] [Indexed: 12/29/2022]
Abstract
Although patients aged > or =75 years represent nearly 40% of all those hospitalized with acute coronary syndromes, their enrollment in trials of therapeutic interventions has been relatively modest. Thus, scarce information exists to guide clinicians in decision-making and assessing projections of safety and efficacy for antiplatelet agents. The pathobiology of aging, including age-related changes in vascular repair and integrity, applies to patient management and offers a platform for investigation. Because older patients receive excess dosing of antithrombotic agents much more often than their younger counterparts do, initial steps toward optimized care include attention to indications, dosing, and duration of treatment. This review, representing a summary of information presented at the Fourth Annual Platelet Colloquium held in Washington, DC, in January 2009 and supplemented with recent clinical trial results, underscores an increasingly narrow safety index for antiplatelet agents in the elderly and the all-important balance of safety and efficacy--a dynamic continuum that remains paramount in quality of care. Considerations for future trial designs, registries, and analyses of existing data are highlighted to better guide clinicians toward the optimal management of this rapidly growing, high-risk group.
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Affiliation(s)
- Harold L Dauerman
- University of Vermont College of Medicine, Burlington, VT 05403, USA.
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When Blood Is Not an Option: Factors Affecting Survival After the Use of a Hemoglobin-Based Oxygen Carrier in 54 Patients with Life-Threatening Anemia. Anesth Analg 2010; 110:685-93. [DOI: 10.1213/ane.0b013e3181cd473b] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sattur S, Harjai KJ, Narula A, Devarakonda S, Orshaw P, Yaeger K. The influence of anemia after percutaneous coronary intervention on clinical outcomes. Clin Cardiol 2010; 32:373-9. [PMID: 19609888 DOI: 10.1002/clc.20542] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although the consequences of bleeding after percutaneous coronary intervention (PCI) are well documented, there are no data on the impact of post-PCI anemia (PPA) on clinical outcomes. METHODS We evaluated the incidence, predictors, and prognostic implications of PPA on clinical outcomes in 1415 PCI procedures. We compared clinical outcomes of patients with PPA (ie, nadir post-PCI hemoglobin < 10 gm/dL) vs without PPA. In patients with PPA, we assessed the influence of thrombolysis in myocardial infarction (TIMI; major or minor) bleeding, drop in hemoglobin by > or = 3 gm/dL, and use of blood transfusions on outcomes. RESULTS Post-PCI anemia developed in 124 (8.8%) patients. Of these, 50 (40%) suffered TIMI (major or minor) bleeding, 68 (55%) had a hemoglobin drop of > or = 3 gm/dL, and 39 (32%) patients received blood transfusions. Compared to patients without PPA, those with PPA had greater incidence of 6 month death (6.5% vs 1.7 %, p = 0.003), 6 month major adverse cardiovascular event (MACE; death, reinfarction, or target vessel revascularization; 27.3% vs 14.5%, p = 0.0006), and long-term mortality (25.8% vs 8.7 %, p <or= 0.0001). After adjustment for baseline differences, PPA showed an independent association with 6 month MACE (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.5-3.9) and long-term mortality (hazard ratio [HR]: 1.3, 95% CI: 1.0-1.6). In patients who developed PPA, the occurrence of TIMI (major or minor) bleeding, hemoglobin drop of > or = 3 gm/dL, and use of blood transfusions did not impact outcomes. CONCLUSION We found that PPA is common, occurs frequently in the absence of bleeding or significant drop in hemoglobin, and connotes poor long-term outcomes.
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Affiliation(s)
- Sudhakar Sattur
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
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Cohen M. Antiplatelet therapy in percutaneous coronary intervention: a critical review of the 2007 AHA/ACC/SCAI guidelines and beyond. Catheter Cardiovasc Interv 2009; 74:579-97. [PMID: 19472347 DOI: 10.1002/ccd.22021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antiplatelet therapy is a mainstay in the treatment of patients who have undergone percutaneous coronary intervention (PCI). Although the 2007 PCI treatment guidelines were published by the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions, new clinical evidence has emerged, expanding our understanding of antiplatelet use and potentially affecting the treatment guidelines. For example, clinical trial results prompted a Science Advisory to recommend that dual therapy with aspirin and clopidogrel be used for longer periods-up to 1 year in patients who receive bare metal stents and at least 1 year in patients receiving drug-eluting stents. New trial results have also emerged regarding the use of glycoprotein IIb/IIIa antagonists such as abciximab, eptifibatide, and tirofiban. This article reviews the current recommendations for antiplatelet therapy in PCI patients, recent trial results, newly developed agents, ongoing clinical trials, and the future direction of antiplatelet therapy in patients who undergo PCI.
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Affiliation(s)
- Marc Cohen
- Newark Beth Israel Medical Center, Newark, NJ, USA.
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Maluenda G, Lemesle G, Collins SD, Ben-Dor I, Syed AI, Torguson R, Kaneshige K, Xue Z, Pakala R, Suddath WO, Satler LF, Kent KM, Lindsay J, Pichard AD, Waksman R. The clinical significance of hematocrit values before and after percutaneous coronary intervention. Am Heart J 2009; 158:1024-30. [PMID: 19958871 DOI: 10.1016/j.ahj.2009.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/09/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND The presence of anemia before percutaneous coronary intervention (PCI) and/or the development of bleeding or anemia after PCI has been shown to increase mortality and morbidity rates. However, the definition of severe anemia varies among reports. In this context, the roles of hematocrit at baseline and hematocrit drop after PCI, both treated as continuous variables, have not yet been described in the risk assessment of patients undergoing PCI. METHODS We analyzed 6,025 consecutive patients who underwent PCI from 2003 to 2007 at our institution. In the entire population, we analyzed by multivariable Cox analysis the clinical value of both hematocrit at baseline and hematocrit drop after PCI as continuous variables. The primary end point was the composite of death and myocardial infarction at 1-year follow-up. RESULTS The rate of the 1-year composite end point death/myocardial infarction increased continuously every time hematocrit at baseline decreased and/or hematocrit dropped after PCI. After multivariable adjustment using the relevant covariables, both hematocrit at baseline (hazard ratio = 0.92, P < .001) and hematocrit drop after PCI (hazard ratio = 1.11, P < .001) strongly predicted the primary end point at 1-year follow-up. CONCLUSION Hematocrit at baseline and the drop after PCI should be recognized as important risk factors for adverse outcomes after PCI. The inclusion of hematocrit or hemoglobin values as continuous variables in a risk-stratification scheme should be strongly considered.
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Louvard Y, Kumar S, Lefèvre T. [Percentage of transradial approach for interventional cardiology in the world and learning the technique]. Ann Cardiol Angeiol (Paris) 2009; 58:327-332. [PMID: 19896641 DOI: 10.1016/j.ancard.2009.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The transradial approach has been used for the first non selective coronary angiographies but was quickly replaced by the femoral approach until a new birth in 1989 for coronary angiography in 1989 and coronary angioplasty in 1992. Transradial approach use is extremely heterogeneous in the world, dominated by some countries in Europe, Canada, and eastern Asia (India, Taiwan, China, Japan). Risk factors of failure have been well described, allowing two kinds of learning: systematic attempt in all kind of patients when working with a proctor; patient selection when beginning the technique alone in order to get a high and stable success rate from the beginning. Systematic radial approach for coronary angiography is a must to learn the technique.
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Affiliation(s)
- Y Louvard
- ICPS, institut hospitalier Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France.
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Bassand JP, Afzal R, Eikelboom J, Wallentin L, Peters R, Budaj A, Fox KAA, Joyner CD, Chrolavicius S, Granger CB, Mehta S, Yusuf S. Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes. Eur Heart J 2009; 31:50-8. [PMID: 19825809 DOI: 10.1093/eurheartj/ehp401] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS In patients with acute coronary syndromes (ACS), the negative impact of baseline haemoglobin levels on ischaemic events, particularly death, is well established, but the association with bleeding risk is less well studied. The aim of this study was to assess the impact of baseline haemoglobin levels on major bleeding complications. METHODS AND RESULTS Pooled analysis of OASIS 5 and 6 data involving 32 170 patients with ACS with and without ST-segment elevation was performed. The association between baseline haemoglobin and major bleeding or ischaemic events was examined using multiple regression model. MAIN OUTCOME MEASURES were 30-day rates of major bleeding, death, and death/myocardial infarction (MI) analysed according to baseline haemoglobin levels. Baseline haemoglobin level independently predicted the risk of overall, procedure-related, and non-procedure-related major bleedings at 30 days [odds ratio (OR) 0.94, 95% CI 0.90-0.98; OR 0.94, 95% CI 0.90-0.99; and OR 0.89, 95% CI 0.83-0.95, respectively, per 1 g/dL haemoglobin increment above 10 g/dL]. In addition, a curvilinear relationship between baseline haemoglobin levels and death at 30 days was observed with a 6% decrease in the risk for every 1 g/dL haemoglobin increment above 10 g/dL up to 15.9 g/dL (OR 0.94, 95% CI 0.90-0.98) and a 19% increase above this value (OR 1.19, 95% CI, 0.98-1.43). A similar relationship for the composite outcome of death/MI was observed. CONCLUSION A low baseline haemoglobin level is an independent predictor of the risk of major bleeding in ACS as well as of the risk of death and death and MI. Among other predictors of bleeding risk, baseline haemoglobin should be taken into account in patients presenting with ACS. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov number, NCT00139815. http://clinicaltrials.gov/ct2/show/NCT00139815?term=NCT00139815&rank=1.
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Affiliation(s)
- Jean-Pierre Bassand
- Department of Cardiology, University Hospital Jean Minjoz, EA 3920, 25000 Besançon, France.
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Cecchi E, Marcucci R, Paniccia R, Bandinelli B, Valente S, Giglioli C, Lazzeri C, Gensini GF, Abbate R, Mannini L. Effect of blood hematocrit and erythrocyte deformability on adenosine 5'-diphosphate platelet reactivity in patients with acute coronary syndromes on dual antiplatelet therapy. Am J Cardiol 2009; 104:764-8. [PMID: 19733708 DOI: 10.1016/j.amjcard.2009.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/02/2009] [Accepted: 05/02/2009] [Indexed: 12/01/2022]
Abstract
Previous studies have explored the association between hemorheologic alterations and aspirin resistance, pointing out the possible interaction between hematologic components and platelet responsiveness to antiplatelet drugs. The aim of this study was to evaluate the association between hemorheologic variables and residual platelet reactivity in patients with acute coronary syndromes (ACSs) who underwent percutaneous coronary intervention on dual antiplatelet therapy. The study population included 528 patients with ACSs. Hemorheologic studies were performed by assessing whole blood viscosity at 0.512 and 94.5/second, plasma viscosity, and erythrocyte deformability index. Post-treatment platelet reactivity was investigated by measuring platelet aggregation by adenosine 5'-diphosphate (ADP) 10 mumol and a value >70% was defined as high ADP platelet reactivity. Significantly (p <0.01) lower values of hematocrit and erythrocyte deformability and higher values of whole blood viscosity at 94.5/second were found in patients with high ADP platelet reactivity. At multivariate analysis, lower values of hematocrit and erythrocyte deformability index and higher values of whole blood viscosity at 94.5/second and leukocytes (highest vs lowest tertile) also resulted in an independent association with high platelet reactivity, except for leukocytes, after simultaneous adjustment for hematocrit, leukocyte count, and erythrocyte deformability index. In conclusion, these results demonstrate the influence of hematocrit and of erythrocyte deformability on ADP platelet reactivity. These variables could be considered to optimize treatment with antiplatelet therapy in these patients.
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Affiliation(s)
- Emanuele Cecchi
- Dipartimento di Area Critica Medico-Chirurgica, Centro Trombosi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Moscucci M. Anemia and blood transfusion: Prognostic implications in patients undergoing contemporary percutaneous coronary intervention. Curr Cardiol Rep 2009; 11:363-8. [DOI: 10.1007/s11886-009-0050-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- Steven V Manoukian
- Sarah Cannon Research Institute, Clinical Services Group, Hospital Corporation of America (HCA), Inc., and Centennial Heart Cardiovascular Consultants, 3322 West End Avenue, Nashville, TN 37203, USA.
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Willis P, Voeltz MD. Anemia, hemorrhage, and transfusion in percutaneous coronary intervention, acute coronary syndromes, and ST-segment elevation myocardial infarction. Am J Cardiol 2009; 104:34C-8C. [PMID: 19695359 DOI: 10.1016/j.amjcard.2009.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advances in antithrombotic and antiplatelet therapies have led to a reduction in ischemic event rates in percutaneous coronary intervention (PCI), acute coronary syndromes (ACS), and ST-segment elevation myocardial infarction (STEMI) but have generally resulted in an increased risk of hemorrhagic complications. In these settings, both baseline anemia and acute hemorrhage occur with relative frequency and are associated with increased morbidity and mortality. Although commonly treated with blood transfusion, this intervention may accentuate rather than attenuate both short-term and long-term risk. This review discusses the pathophysiology of anemia and the impact of anemia and transfusion on morbidity and mortality in PCI, ACS, and STEMI.
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Affiliation(s)
- Patrick Willis
- Emory University School of Medicine, Atlanta, GA 30308, USA
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Manoukian SV. Predictors and impact of bleeding complications in percutaneous coronary intervention, acute coronary syndromes, and ST-segment elevation myocardial infarction. Am J Cardiol 2009; 104:9C-15C. [PMID: 19695355 DOI: 10.1016/j.amjcard.2009.06.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although the use of oral and intravenous antiplatelet and antithrombin therapy in the acute and chronic settings of percutaneous coronary intervention (PCI), acute coronary syndromes (ACS), and ST-segment elevation myocardial infarction (STEMI) effectively reduce ischemic event rates, they are mechanistically and inextricably linked to an increased risk of bleeding. As longer courses of more complex, potent regimens are used, increased efficacy may be offset by increases in major, minor, and nuisance bleeding, both in the inpatient and outpatient setting. Consequently, more frequent challenges with cessation of and compliance with antithrombotic therapy are to be expected. Extensive data indicate that bleeding complications (1) occur with relative frequency; (2) independently affect adverse outcomes, such as mortality; (3) carry similar importance in adversely influencing mortality as ischemic events; (4) can be predicted by recognizing patient, presentation, treatment, and procedural risk factors for bleeding; and (5) can be modified by pharmacologic and nonpharmacologic means. Factors associated with increased bleeding risk include: (1) patient characteristics (including advanced age, female sex, hypertension, renal disease, anemia, previous history of bleeding, and perhaps diabetes mellitus), (2) clinical presentation (bleeding rates appears lowest for PCI, higher for ACS, and highest for STEMI), (3) abnormalities of cardiac biomarkers and/or electrocardiography, (4) invasive procedures (such as cardiac catheterization and PCI), and (5) the choice of antiplatelet and antithrombin therapy. In the context of a bleeding assessment, evidence-based decision making should always result in the selection of appropriate pharmacologic and nonpharmacologic strategies, invasive or conservative management plans, and stent types (bare metal vs drug-eluting) that will offer the best balance of benefit and risk with the goal of optimizing outcomes.
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Affiliation(s)
- Steven V Manoukian
- Sarah Cannon Research Institute, Clinical Services Group, Hospital Corporation of America (HCA), Inc., and Centennial Heart Cardiovascular Consultants, 3322 West End Avenue, Nashville, TN 37203, USA.
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Lemesle G, De Labriolle A, Bonello L, Syed A, Collins S, Maluenda G, Torguson R, Kaneshige K, Xue Z, Suddath WO, Satler LF, Kent KM, Lindsay J, Pichard AD, Waksman R. Impact of bivalirudin on in-hospital bleeding and six-month outcomes in octogenarians undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2009; 74:428-35. [DOI: 10.1002/ccd.22007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Meneveau N, Schiele F, Seronde MF, Descotes-Genon V, Oettinger J, Chopard R, Ecarnot F, Bassand JP. Anemia for risk assessment of patients with acute coronary syndromes. Am J Cardiol 2009; 103:442-7. [PMID: 19195499 DOI: 10.1016/j.amjcard.2008.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 10/13/2008] [Accepted: 10/13/2008] [Indexed: 12/22/2022]
Abstract
In patients admitted with acute coronary syndromes, those with anemia are at higher risk. However, current risk score systems do not take into account the presence of anemia. The impact of anemia on mortality was studied, and its incremental predictive value was evaluated. Demographic, clinical, and biologic characteristics at admission, as well as treatments and mortality, were recorded for 1,410 consecutive patients with acute coronary syndromes. The incremental value of adding anemia information to risk score evaluation was determined using changes in the appropriateness of Cox models when anemia was added. Anemia was detected in 381 patients (27%). They were older, had more co-morbidities, had higher Global Registry of Acute Coronary Events (GRACE) risk scores, received fewer guideline-recommended treatments, and, as a result, had 4-fold higher mortality. When included in a prediction model based on the GRACE risk score, anemia remained an independent predictor of mortality. The addition of anemia improved both the discriminatory capacity and calibration of the models. According to the GRACE risk score, the population was divided into 4 groups of different risk levels of <1%, 1% to <5%, 5% to <10%, and > or =10%. The addition of anemia to the model made it possible to reclassify 9%, 43%, 47%, and 23% of patients into the different risk categories, respectively. In conclusion, our data confirmed that anemia was an independent predictive factor of mortality and had incremental predictive value to the GRACE score system for early clinical outcomes.
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LEMESLE GILLES, BONELLO LAURENT, DE LABRIOLLE AXEL, STEINBERG DANIELH, ROY PROBAL, SLOTTOW TINALPINTO, TORGUSON REBECCA, KANESHIGE KIMBERLY, XUE ZHENYI, SUDDATH WILLIAMO, SATLER LOWELLF, KENT KENNETHM, LINDSAY JOSEPH, PICHARD AUGUSTOD, WAKSMAN RON. Impact of Bivalirudin Use on Outcomes in Nonagenarians Undergoing Percutaneous Coronary Intervention. J Interv Cardiol 2009; 22:61-7. [DOI: 10.1111/j.1540-8183.2008.00422.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hematologic parameters, atherosclerotic progression, and prognosis in patients with previous coronary artery bypass grafting (from the Post CABG Trial). Am J Cardiol 2009; 103:328-32. [PMID: 19166684 DOI: 10.1016/j.amjcard.2008.09.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/12/2008] [Accepted: 09/12/2008] [Indexed: 11/24/2022]
Abstract
Although inflammatory markers and anemia have both been associated with prognosis in patients with cardiovascular disease, their relation with atherosclerotic progression in patients with previous coronary artery bypass grafting (CABG) is unknown. A total of 1,273 patients enrolled in the Post CABG Trial who had undergone CABG 1 to 11 years before entry were studied. Subjects were randomly assigned to lovastatin in low or high doses and low-dose warfarin or placebo in a factorial design. Subjects underwent coronary angiography at baseline and after a mean follow-up of 4.3 years. White blood cells (WBCs), hemoglobin, and platelets were measured at baseline in all subjects. Graft progression was defined as a decrease > or =0.6 mm in lumen diameter at the site of greatest change at follow-up. During follow-up, 195 subjects sustained a clinical event and 857 grafts developed significant worsening. Risk of clinical events tended to be greater with higher WBC counts, with hazard ratios for ascending quartiles of 1.4 (95% confidence interval [CI] 0.9 to 2.2), 1.6 (95% CI 1.0 to 2.6), and 1.6 (95% CI 1.0 to 2.7). WBC count also tended to be associated with significant atherosclerotic progression, particularly in subjects assigned to placebo rather than warfarin (p interaction = 0.04). There was no association of hemoglobin or platelet count with risk of clinical events or graft progression, but few trial subjects were anemic. In conclusion, WBC count is associated with a graded increase in cardiovascular events in patients with coronary artery bypass grafts.
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Bertrand OF, Larose E, Rodés-Cabau J, Gleeton O, Taillon I, Roy L, Poirier P, Costerousse O, Larochellière RD. Incidence, predictors, and clinical impact of bleeding after transradial coronary stenting and maximal antiplatelet therapy. Am Heart J 2009; 157:164-9. [PMID: 19081414 DOI: 10.1016/j.ahj.2008.09.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 09/14/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Bleeding has recently emerged as predictor of early and late mortality after percutaneous coronary intervention (PCI) using femoral approach. Transradial PCI is associated with a lower risk of access-site complications than femoral approach. We evaluated the predictors of bleeding and the impact of major bleeding on death and major adverse cardiac events (MACE) after transradial PCI and maximal antiplatelet therapy. METHODS In the EASY (EArly discharge after transradial Stenting of coronarY arteries) trial, 1,348 patients with acute coronary syndrome were enrolled and underwent transradial PCI. All patients received clopidogrel (90% > or =12 hours pre-PCI) and a bolus of abciximab before first balloon inflation. Univariate and multivariate analyses to identify predictors and prognostic impact of major bleeding on death and MACE (death, myocardial infarction, and target vessel revascularization) were performed. RESULTS From the study population, 19 (1.4%) patients presented major bleeding. Patients with bleeding were older, had lower creatinine clearance, more often had 3-vessel disease and > or =3 dilated sites, and had longer procedures. Independent predictors of bleeding were creatinine clearance <60 mL/min (odds ratio [OR] 3.26, 95% confidence interval [CI] 1.10-8.67, P = .022), procedure duration (OR 2.95, 95% CI 1.12-8.31, P = .032), and sheath size (OR 5.34, 95% CI 1.44-34.65, P = .029). In patients with major bleeding, the incidence of MACE was higher at 30 days (37% vs 3%), 6 months (42% vs 8%), and 12 months (53% vs 12%; P < .0001 for all comparisons). By multivariate analysis, major bleeding was an independent predictive factor of 1-year mortality and MACE. CONCLUSION After transradial PCI and maximal antiplatelet therapy, the incidence of major bleeding remains low. Major bleeding is an independent predictive factor of adverse acute and 1-year outcomes, regardless of the access site.
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Affiliation(s)
- Olivier F Bertrand
- Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Québec City, Québec, Canada.
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Risk Factors for Major Bleeding in Patients With Heparin-induced Thrombocytopenia Treated With Argatroban: A Retrospective Study. J Cardiovasc Pharmacol 2008; 52:561-6. [DOI: 10.1097/fjc.0b013e3181926928] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J 2008; 156:864-70. [PMID: 19061699 DOI: 10.1016/j.ahj.2008.06.044] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/26/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies evaluating the efficacy and safety of the transradial approach for percutaneous coronary intervention (PCI) were carried out mainly before the widespread use of stents and glycoprotein (GP) IIb/IIIa inhibitors. We sought to determine the association between the choice of the vascular access site and procedural complications after PCI performed with routine stenting and GP IIb/IIIa inhibition. METHODS The data source was a prospective registry of 13,499 consecutive cases of PCI at the University Health Network, Toronto, Canada, from April 2000 to September 2006. Logistic regression was used to calculate the probability of selection to the radial access group. Using propensity score methodology, 3,198 patients with femoral access were randomly matched to 3,198 patients with radial access based on clinical, angiographic, and procedural characteristics. Multivariable logistic regression analysis was used to identify the independent predictors of access site-related complications. Major adverse cardiac event was defined as death, myocardial infarction, abrupt vessel closure, or coronary artery bypass surgery. RESULTS Use of the transradial approach was associated with fewer vascular access complications (1.5% vs 0.6%, P<.001) and a shorter length of hospital stay. Multivariable analysis revealed transradial access (OR 0.39, 95% CI 0.2-0.7) to be an independent predictor of lower risk, whereas primary PCI (OR 4.36, 95% CI 1.4, 13), recent myocardial infarction (OR 2.0 95% CI 1.2, 3.4), age (per 10 years increase: OR 1.37, 95% CI 1.1-1.7) and female gender (0R 2.78 95% CI 1.7, 4.6) were independent predictors of a higher risk of access site complications. CONCLUSIONS Use of transradial access for PCI is safe and is independently associated with a reduced rate of in-hospital access site complications and reduced length of hospital stay.
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Ramana RK, Lewis BE. Percutaneous coronary intervention in patients with acute coronary syndrome: focus on bivalirudin. Vasc Health Risk Manag 2008; 4:493-505. [PMID: 18827868 PMCID: PMC2515410 DOI: 10.2147/vhrm.s2455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Previously, indirect thrombin inhibitors such as unfractionated heparin or low-molecular-weight heparin were used as a standard anticoagulation during percutaneous coronary intervention to prevent procedural thrombotic complications but at a risk of hemorrhagic complications. More recently, bivalirudin, a member of the direct thrombin inhibitor class, has been shown to have 1) predictable pharmacokinetics, 2) ability to inhibit free- and clot-bound thrombin, 3) no properties of platelet activation, 4) avoidance of heparin-induced thrombocytopenia, and 5) a significant reduction of bleeding without a reduction in thrombotic or ischemic endpoints compared to heparin and glycoprotein IIbIIIa inhibitors when used in patients presenting with acute coronary syndrome who are planned for an invasive treatment strategy.
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Affiliation(s)
- Ravi K Ramana
- Division of Cardiology, Loyola University Medical Center, Maywood, Illinois 60647, USA.
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Manzano-Fernández S, Pastor FJ, Marín F, Cambronero F, Caro C, Pascual-Figal DA, Garrido IP, Pinar E, Valdés M, Lip GYH. Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting. Chest 2008; 134:559-567. [PMID: 18641090 DOI: 10.1378/chest.08-0350] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal antithrombotic therapy strategy for atrial fibrillation (AF) patients who undergo percutaneous coronary intervention with stent implantation (PCI-S) is unknown. We assessed the safety of antithrombotic therapy strategies in AF patients with indication for oral anticoagulation (OAC) undergoing PCI-S. METHODS We studied consecutive AF patients with indication for OAC who underwent PCI-S. We compared patients that received triple antithrombotic therapy (TT) [aspirin, clopidogrel, and coumadin] against other regimes (non-TT) after PCI-S. The primary end point was defined as the occurrence of major bleeding complications that were termed as early major bleeding (EMB) [< or = 48 h] or late major bleeding (LMB) [> 48 h]. Clinical follow-up was performed, and complications were recorded. RESULTS We studied 104 patients (mean age +/- SD, 72 +/- 8 years; 70% men); TT was used in 51 patients (49%). TT was associated with a higher incidence of LMB (21.6% vs non-TT, 3.8%; p = 0.006) but not of EMB (5.8% vs non-TT, 11.3%; p = 0.33). In multivariate analyses, glycoprotein (GP) IIb/IIIa inhibitor use (hazard ratio [HR], 13.5; 95% confidence interval [CI], 1.7 to 108.3; p = 0.014) and PCI-S of three vessels or left main artery disease (HR, 7.9; 95% CI, 1.6 to 39.2; p = 0.01) were independent predictors for EMB. TT use (HR, 7.1; 95% CI, 1.5 to 32.4; p = 0.012), the occurrence of EMB (HR, 6.7; 95% CI, 1.8 to 25.3; p = 0.005), and baseline anemia (HR, 3.8; 95% CI, 1.2 to 12.5; p = 0.027) were independent predictors for LMB. No differences in major cardiovascular events were observed in patients treated with TT vs non-TT (25.5% vs 21.0%; p = 0.53). CONCLUSION A high rate of major bleeding is observed in AF patients with indication for OAC undergoing PCI-S who receive TT. GP IIb/IIIa inhibitor use and multivessel/left main artery disease during PCI-S were independent predictors for EMB, while TT use, occurrence of EMB, and baseline anemia were independent predictors for LMB.
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Affiliation(s)
| | - Francisco J Pastor
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Cambronero
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Cesar Caro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Iris P Garrido
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Pinar
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Mariano Valdés
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Gregory Y H Lip
- University Department of Medicine, City Hospital, Birmingham, UK.
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