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Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention

Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention
Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention

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.

Anemia/epidemiology, Coronary Artery Disease/epidemiology, Hemoglobins/metabolism, Humans, Mortality, Myocardial Infarction/epidemiology, Odds Ratio, Percutaneous Coronary Intervention, Postoperative Complications/epidemiology, Postoperative Hemorrhage/epidemiology, Prevalence, Prognosis, Risk Factors
0002-9149
610-620
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Tiong, Denise
8f35ea7a-fccb-4ec4-8cd6-0fb51c2838a0
Pradhan, Ashish
1c3a583f-d900-4dc7-aeb1-68477017e3b2
Andreou, Andreas Y.
455c98d5-5a6a-4e7b-beb6-c02feea5420e
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Bertrand, Olivier F.
44c041f9-1c6e-4d69-9394-2cef284f2af7
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Urban, Philip
4e78258e-0cb6-42f3-b5c8-db5879bc565c
Myint, Phyo K.
c34a336f-bdc1-4d4e-a8cb-7a29b7269765
Zaman, Azfar G.
dadf7e3e-f6b2-429b-8344-b84347f68da5
Loke, Yoon K.
560eac6b-d8b2-491a-9e2d-fae957da61bd
Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Tiong, Denise
8f35ea7a-fccb-4ec4-8cd6-0fb51c2838a0
Pradhan, Ashish
1c3a583f-d900-4dc7-aeb1-68477017e3b2
Andreou, Andreas Y.
455c98d5-5a6a-4e7b-beb6-c02feea5420e
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
Bertrand, Olivier F.
44c041f9-1c6e-4d69-9394-2cef284f2af7
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Urban, Philip
4e78258e-0cb6-42f3-b5c8-db5879bc565c
Myint, Phyo K.
c34a336f-bdc1-4d4e-a8cb-7a29b7269765
Zaman, Azfar G.
dadf7e3e-f6b2-429b-8344-b84347f68da5
Loke, Yoon K.
560eac6b-d8b2-491a-9e2d-fae957da61bd
Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d

Kwok, Chun Shing, Tiong, Denise, Pradhan, Ashish, Andreou, Andreas Y., Nolan, James, Bertrand, Olivier F., Curzen, Nick, Urban, Philip, Myint, Phyo K., Zaman, Azfar G., Loke, Yoon K. and Mamas, Mamas A. (2016) Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention. The American Journal of Cardiology, 118 (4), 610-620. (doi:10.1016/j.amjcard.2016.05.059).

Record type: Review

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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More information

Accepted/In Press date: 23 May 2016
e-pub ahead of print date: 29 May 2016
Published date: 15 August 2016
Keywords: Anemia/epidemiology, Coronary Artery Disease/epidemiology, Hemoglobins/metabolism, Humans, Mortality, Myocardial Infarction/epidemiology, Odds Ratio, Percutaneous Coronary Intervention, Postoperative Complications/epidemiology, Postoperative Hemorrhage/epidemiology, Prevalence, Prognosis, Risk Factors

Identifiers

Local EPrints ID: 436146
URI: http://eprints.soton.ac.uk/id/eprint/436146
ISSN: 0002-9149
PURE UUID: 405c8b55-a11f-4a5a-a389-ce9e0ee1a0f6
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 29 Nov 2019 17:30
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Chun Shing Kwok
Author: Denise Tiong
Author: Ashish Pradhan
Author: Andreas Y. Andreou
Author: James Nolan
Author: Olivier F. Bertrand
Author: Nick Curzen ORCID iD
Author: Philip Urban
Author: Phyo K. Myint
Author: Azfar G. Zaman
Author: Yoon K. Loke
Author: Mamas A. Mamas

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