Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention

Byung Gyu Kim, Hyoeun Kim, Sung Jin Hong, Chul Min Ahn, Dong Ho Shin, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang, Byeong Keuk Kim, Byoung Kwon Lee

Research output: Contribution to journalArticle

Abstract

Adverse effects have been reported in patients with preprocedural anemia after percutaneous coronary intervention (PCI), but data regarding the relation between elevated hemoglobin (Hb) level and post-PCI prognosis remain limited. This study assessed the impact of elevated Hb on major adverse cardiac and cerebrovascular event (MACCE) at 12 months, a composite of all-cause mortality, nonfatal myocardial infarction, and ischemic stroke after PCI. We pooled patient-level data from four Korean multicenter drug-eluting stent registries from 2010 to 2016. In total, 5,107 patients were divided into 5 categories according to the baseline Hb level (<10, 10 to 12.9, 13 to 14.9, 15 to 16.9 and ≥17 g/dl). Patients with higher Hb levels were significantly younger, predominantly male, current smokers with higher body mass index, and more frequent dyslipidemia. Hypertension, diabetes, chronic kidney disease, and cerebrovascular accident were more prevalent in lower Hb groups. Categorically, a U-shaped curvilinear relation was observed between baseline Hb and clinical outcomes showing significantly higher MACCE rate in <10g/dl (hazard ratio [HR], 4.62 [2.81 to 7.68]) and ≥17 g/dl (HR, 4.06 [1.57 to 10.5]) groups compared with the reference group (13 to 14.9 g/dl), especially in men. In nonanemic patients (Hb ≥13 g/dl), adjusted HRs of MACCE, mortality, and stroke were significantly higher in ≥17 g/dl group than in the reference group. Furthermore, ≥17 g/dl was an independent predictor for MACCE and all-cause mortality after PCI. In conclusion, not only low Hb but also elevated Hb of ≥17 g/dl was significantly associated with higher MACCE rates and all-cause mortality after PCI. An appropriate treatment strategy for patients with high Hb level should be identified through future studies.

Original languageEnglish
Pages (from-to)1319-1326
Number of pages8
JournalAmerican Journal of Cardiology
Volume124
Issue number9
DOIs
Publication statusPublished - 2019 Nov 1

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Kim, B. G., Kim, H., Hong, S. J., Ahn, C. M., Shin, D. H., Kim, J. S., Ko, Y. G., Choi, D., Hong, M. K., Jang, Y., Kim, B. K., & Lee, B. K. (2019). Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention. American Journal of Cardiology, 124(9), 1319-1326. https://doi.org/10.1016/j.amjcard.2019.07.056