Implications of Anemia in Patients Undergoing PCI with Impella-support: Insights from the PROTECT III Study

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 2

PMID 39091353

Authors

Batla Falah

Bjorn Redfors

Duzhi Zhao

Aditya S Bharadwaj

Mir Babar Basir

Julia B Thompson

Rajan A G Patel

Michael J Schonning

Arsalan Abu-Much

Yiran Zhang

Wayne B Batchelor

Cindy L Grines

William W ONeill

Affiliations

Soon will be listed here.

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%; = 0.02) and at 90 days (moderate to severe, 18.7%; mild, 14.6%; none, 8.3%; = 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%, = 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. Trial Name: The Global cVAD Study (cVAD)ClinicalTrial.gov Identifier: NCT04136392URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2.

References

Guedeney P, Sorrentino S, Claessen B, Mehran R . The link between anemia and adverse outcomes in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther. 2019; 17(3):151-159. DOI: 10.1080/14779072.2019.1575729. View

Go A, Chertow G, Fan D, McCulloch C, Hsu C . Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351(13):1296-305. DOI: 10.1056/NEJMoa041031. View

Menon V, Sarnak M . The epidemiology of chronic kidney disease stages 1 to 4 and cardiovascular disease: a high-risk combination. Am J Kidney Dis. 2005; 45(1):223-32. DOI: 10.1053/j.ajkd.2004.09.022. View

. 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(9):e713-e734. PMC: 10465717. DOI: 10.1016/S2352-3026(23)00160-6. View

Nikolsky E, Aymong E, Halkin A, Grines C, Cox D, Garcia E . Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol. 2004; 44(3):547-53. DOI: 10.1016/j.jacc.2004.03.080. View

Sabatine M, Morrow D, Giugliano R, Burton P, Murphy S, McCabe C . Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005; 111(16):2042-9. DOI: 10.1161/01.CIR.0000162477.70955.5F. View

Farhan S, Baber U, Mehran R . Anemia and Acute Coronary Syndrome: Time for Intervention Studies. J Am Heart Assoc. 2016; 5(11). PMC: 5210317. DOI: 10.1161/JAHA.116.004908. View

Tang Y, Katz S . Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation. 2006; 113(20):2454-61. DOI: 10.1161/CIRCULATIONAHA.105.583666. View

Strom J, Zhao Y, Shen C, Chung M, Pinto D, Popma J . Hospital Variation in the Utilization of Short-Term Nondurable Mechanical Circulatory Support in Myocardial Infarction Complicated by Cardiogenic Shock. Circ Cardiovasc Interv. 2019; 12(1):e007270. PMC: 6424352. DOI: 10.1161/CIRCINTERVENTIONS.118.007270. View

10.

Carson J, Brooks M, Hebert P, Goodman S, Bertolet M, Glynn S . Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med. 2023; 389(26):2446-2456. PMC: 10837004. DOI: 10.1056/NEJMoa2307983. View

11.

Al Falluji N, Lawrence-Nelson J, Kostis J, Lacy C, Ranjan R, Wilson A . Effect of anemia on 1-year mortality in patients with acute myocardial infarction. Am Heart J. 2002; 144(4):636-41. DOI: 10.1067/mhj.2002.124351. View

12.

Kirtane A, Doshi D, Leon M, Lasala J, Ohman E, ONeill W . Treatment of Higher-Risk Patients With an Indication for Revascularization: Evolution Within the Field of Contemporary Percutaneous Coronary Intervention. Circulation. 2016; 134(5):422-31. PMC: 9117111. DOI: 10.1161/CIRCULATIONAHA.116.022061. View

13.

Amin A, Spertus J, Curtis J, Desai N, Masoudi F, Bach R . The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support. Circulation. 2019; 141(4):273-284. DOI: 10.1161/CIRCULATIONAHA.119.044007. View

14.

Chonchol M, Whittle J, Desbien A, Orner M, Petersen L, Kressin N . Chronic kidney disease is associated with angiographic coronary artery disease. Am J Nephrol. 2007; 28(2):354-60. DOI: 10.1159/000111829. View

15.

Kwok C, Tiong D, Pradhan A, Andreou A, Nolan J, Bertrand O . Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol. 2016; 118(4):610-20. DOI: 10.1016/j.amjcard.2016.05.059. View

16.

Mehta S, Frutkin A, Lindsey J, House J, Spertus J, Rao S . Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry. Circ Cardiovasc Interv. 2009; 2(3):222-9. DOI: 10.1161/CIRCINTERVENTIONS.108.846741. View

17.

ONeill W, Anderson M, Burkhoff D, Grines C, Kapur N, Lansky A . Improved outcomes in patients with severely depressed LVEF undergoing percutaneous coronary intervention with contemporary practices. Am Heart J. 2022; 248:139-149. DOI: 10.1016/j.ahj.2022.02.006. View

18.

Kosiborod M, Curtis J, Wang Y, Smith G, Masoudi F, Foody J . Anemia and outcomes in patients with heart failure: a study from the National Heart Care Project. Arch Intern Med. 2005; 165(19):2237-44. DOI: 10.1001/archinte.165.19.2237. View

19.

Shah T, Abu-Much A, Batchelor W, Grines C, Baron S, Zhou Z . Sex Differences in pLVAD-Assisted High-Risk Percutaneous Coronary Intervention: Insights From the PROTECT III Study. JACC Cardiovasc Interv. 2023; 16(14):1721-1729. DOI: 10.1016/j.jcin.2023.04.036. View

20.

Razuk V, Camaj A, Cao D, Nicolas J, Hengstenberg C, Sartori S . Impact of anemia on short-term outcomes after TAVR: A subgroup analysis from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv. 2021; 98(6):E870-E880. DOI: 10.1002/ccd.29753. View