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. 2024 Jul 18:11:1429900.
doi: 10.3389/fcvm.2024.1429900. eCollection 2024.

Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study

Batla Falah  1 , Björn Redfors  1   2   3 , Duzhi Zhao  1 , Aditya S Bharadwaj  4 , Mir Babar Basir  5 , Julia B Thompson  1 , Rajan A G Patel  6 , Michael J Schonning  1 , Arsalan Abu-Much  1 , Yiran Zhang  1 , Wayne B Batchelor  7 , Cindy L Grines  8 , William W O'Neill  5
Affiliations

Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study

Batla Falah et al. Front Cardiovasc Med. .

Abstract

Background: Anemia is prevalent among patients with cardiovascular disease and is associated with adverse outcomes. However, data regarding the impact of anemia in high-risk percutaneous coronary intervention (HRPCI) are limited.

Objectives: This study aimed to evaluate the impact of anemia in patients undergoing Impella-supported HRPCI in the PROTECT III study.

Methods: Patients undergoing Impella-supported HRPCI in the multicenter PROTECT III study were assessed for anemia based on baseline hemoglobin levels according to World Health Organization criteria. Patients were stratified into three groups, namely, no anemia, mild anemia, and moderate or severe anemia. Major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days, and major bleeding events were compared across groups.

Results: Of 1,071 patients with baseline hemoglobin data, 37.9% had no anemia, 43.4% had mild anemia, and 18.7% had moderate or severe anemia. Anemic patients were older and more likely to have comorbidities. Anemia was associated with higher MACCE rates at 30 days (moderate to severe, 12.3%; mild, 9.8%; no anemia, 5.4%; p = 0.02) and at 90 days (moderate to severe, 18.7%; mild, 14.6%; none, 8.3%; p = 0.004). These differences persisted after adjustment for potential confounders at 30 and 90 days, and sensitivity analysis excluding dialysis showed similar results. Major bleeding at 30 days was also higher in anemic patients (5.5% vs. 1.2%, p = 0.002).

Conclusion: Baseline anemia in Impella-supported HRPCI is common and independently associated with MACCE and major bleeding, emphasizing its significance as a prognostic factor. Specific management strategies to reduce anemia-associated MACCE risk after HRPCI should be examined. Clinical Trial Information Trial Name: The Global cVAD Study (cVAD)ClinicalTrial.gov Identifier: NCT04136392URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2.

Keywords: anemia; bleeding; dialysis; high-risk percutaneous coronary intervention; major adverse cardiovascular and cerebrovascular event.

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Conflict of interest statement

BR reports consultant fees from Pfizer and Boehringer Ingelheim. ASB reports consulting and speaker fees from Abiomed, Shockwave Medical, and Cardiovascular Systems, Inc. MBB discloses consultant/speaker fees from Abiomed, Boston Scientific, Chiesi, Saranas, and Zoll. RAGP reports consultant/speaker fees from Abiomed; speaker honoraria Boston Scientific. WBB reports consultant fees from Abbott, Medtronic, Abiomed, and Boston Scientific. CLG reports participation on the advisory boards for Philips and Abiomed. WWO reports grant/research support from St. Jude Medical, Edwards Lifesciences, and BioMed; consulting fees/honoraria from Medtronic and Abiomed; and major stock shareholder/equity in Synecor, Accumed, Neovasc, Tendyne, and Mitralign. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. World Health Organization (2000) has defined mild anemia as hemoglobin 11–11.9 g/dL in women and 11–12.9 g/dL in men; moderate anemia as hemoglobin 8–10.9 g/dL; and severe anemia as hemoglobin <8 g/dL.
Figure 2
Figure 2
Kaplan–Meier curves for 30- and 90-day MACCE stratified by severity of anemia. MACCE denotes major adverse cardiovascular and cerebrovascular events.
Figure 3
Figure 3
Forest plot of the adjusted hazard ratio for MACCE rates estimated by cox proportional hazards regression models at (A) 30 days and (B) 90 days. eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction.
Figure 4
Figure 4
Kaplan–Meier curves for all-cause mortality at 1 year stratified by severity of anemia.
Figure 5
Figure 5
Forest plot of the adjusted odds ratio for blood transfusion for different variables. Odds ratios (OR) and 95% confidence intervals (95% CI) are estimated by multiple logistic regression models. Prolonged support Impella is defined as any Impella support beyond the index procedure.
See this image and copyright information in PMC

References

    1. Collaborators GBDA. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. (2023) 10:e713–34. 10.1016/S2352-3026(23)00160-6 - DOI - PMC - PubMed
    1. AÏdoud A, Gana W, Poitau F, Debacq C, Leroy V, Nkodo JA, et al. High prevalence of geriatric conditions among older adults with cardiovascular disease. J Am Heart Assoc. (2023) 12(2):e026850. 10.1161/JAHA.122.026850 - DOI - PMC - PubMed
    1. Anker SD, Voors A, Okonko D, Clark AL, James MK, von Haehling S, et al. Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial. Eur Heart J. (2009) 30(11):1331–9. 10.1093/eurheartj/ehp116 - DOI - PubMed
    1. Faggioni M, Baber U, Sartori S, Chandrasekhar J, Cohen DJ, Henry TD, et al. Influence of baseline anemia on dual antiplatelet therapy cessation and risk of adverse events after percutaneous coronary intervention. Circ Cardiovasc Interv. (2019) 12(4):e007133. 10.1161/CIRCINTERVENTIONS.118.007133 - DOI - PubMed
    1. Tsujita K, Nikolsky E, Lansky AJ, Dangas G, Fahy M, Brodie BR, et al. 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(10):1385–94. 10.1016/j.amjcard.2010.01.001 - DOI - PubMed

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