Anemia Predicts Adverse Outcomes in High-Risk PCI Patients with Impella Support, reports study

This study was intended to investigate the impact of baseline anemia on the outcome of patients undergoing Impella-supported HRPCI with respect to the incidence of MACCE, bleeding events, and overall mortality.

Anemia is commonly identified at baseline in patients undergoing high-risk PCI procedures. There are, however, no specific recommendations in current clinical practice guidelines regarding the management of anemia in patients undergoing PCI or large-bore procedures such as Impella-supported HRPCI. Nearly a quarter of the worldwide population has anemia, most of whom are aged 65 or older; it is by itself associated with worse outcomes in the setting of cardiac procedures, including PCI and transcatheter aortic valve replacement.

PROTECT III enrolled 1,237 patients who underwent Impella-supported HRPCI at 46 sites in North America from March 2017 through March 2020. Of those, 1,071 had baseline hemoglobin data available and were stratified into three cohorts based on WHO hemoglobin criteria: no anemia, mild anemia, and moderate to severe anemia.

Using WHO hemoglobin criteria, patients were classified into no anemia, ≥12 mg/dL for women and ≥13 mg/dL for men, mild anemia, ≥10 to <12 mg/dL for women and ≥10 to <13 mg/dL for men, and moderate or severe anemia, <10 mg/dL for both. The primary endpoint in this study was MACCE through 30 and 90 days. Secondary endpoints incorporated the occurrence of major bleeding events, hospitalization duration, major vascular complication or structural complications needing surgical intervention, and 1-year all-cause mortality.

• At baseline, 62.1% of the population was anemic, of whom 43.4% had mild and 18.7% had moderate-to-severe anemia.

• Patients with anemia were older and more likely to have cardiovascular disease, chronic kidney disease, and diabetes.

• MACCE rates at 30 days in patients with moderate to severe anemia versus mild anemia versus no anemia were 12.3% versus 9.8% versus 5.4% (P=0.02), respectively, and at 90 days they were 18.7% versus 14.6% versus 8.3% (P = 0.004),.

• In multivariable analysis adjusted for age, sex, left ventricular ejection fraction, and eGFR, even mild anemia and moderate-severe anemia remained associated with a higher rate of MACCE at 30 and 90 days. Sensitivity analysis excluded patients that required dialysis to achieve femoral access, and the same association was noted.

• Moderate-severe anemia and mild anemia were associated with an increase in the rate of major bleeding events compared with no anemia 5.5% vs 1.2%; P =.002.

• In this study, moderate-to-severe anemia was independently related to major bleeding: aOR, 2.53 (95% CI, 1.37-4.68; P = .003).

This study provides emphasis on the very strong association between baseline anemia and poor outcome in patients undergoing Impella-supported high-risk percutaneous coronary intervention. According to these results, one may infer that optimization of anemia management will decrease the rate of adverse events in such high-risk patients.Further studies are required to build relevant guidelines for the management of anemia.

Baseline anemia remains a very potent predictor of poor outcome in patients undergoing Impella-supported HRPCI and calls for targeted interventions, along with anemia management optimization in an attempt to improve patient outcome. Recommendations on anemia management in individuals undergoing high-risk PCI procedures should find a place in future clinical practice guidelines.

Reference:

Sasamoto, N., Ngo, L., Vitonis, A. F., Dillon, S. T., Prasad, P., Laufer, M. R., As-Sanie, S., Schrepf, A., Missmer, S. A., Libermann, T. A., & Terry, K. L. (2024). Plasma proteins and persistent postsurgical pelvic pain among adolescents and young adults with endometriosis. American Journal of Obstetrics and Gynecology, 231(2), 240.e1-240.e11. https://doi.org/10.1016/j.ajog.2024.03.005