Background: Anemia is known predictor for major adverse cardiac events (MACE0 following percutaneous coronary intervention (PCI). We aimed to identify if the changes of hemoglobin following primary PCI is a predictor for 12-month MACE in patients with ST elevation myocardial infarction (STEMI).
Methods: We reviewed the data of 452 patients who presented with STEMI to our center underwent successful primary PCI and were followed-up for 12 months at least. Based on 1 gr/dl decline in hemoglobin level following PCI, patients were dichotomized into two groups and were compared for baseline variables as well as the MACE. We also compared the mean of the hemoglobin difference following the procedures to find out its predictive value.
Results: During 12-month follow-up, we registered 79 cases of MACE in total. Higher frequencies of total MACE as well as CABG were observed in patients with hemoglobin decrease. The mean level of hemoglobin decrease was significantly higher in patients with MACE as compared with MACE-free patients (-1.5±2.5 vs. -0.8±1.5; HR=1.21, 95% CI: 1.07-1.37; P=0.002). After adjustment for confounders, this difference remained significant (HR=1.18, 95% CI: 1.04-1.34; P=0.10).
Conclusion: We observed that changes of hemoglobin before and after the procedure is a predictor for mortality and total MACE.
Joyal D, Bertrand OF, Rinfret S, Shimony A, Eisenberg MJ. Meta-analysis of ten trials on the effectiveness of the radial versus the femoral approach in primary percutaneous coronary intervention. The American journal of cardiology. 2012;109(6):813-8.
Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. The American journal of cardiology. 2012;110(5):621-7.
Namazi MH, Safi M, Vakili H, Saadat H, Karimi E, Bagheri RK. Comparison between Intracoronary Abciximab and Intravenous Eptifibatide Administration during Primary Percutaneous Coronary Intervention of Acute ST-Segment Elevation Myocardial Infarction. The Journal of Tehran University Heart Center. 2013;8(3):132.
Eshraghi A, Talasaz AH, Salamzadeh J, Salarifar M, Pourhosseini H, Nozari Y, et al.
Evaluating the Effect of Intracoronary N-Acetylcysteine on Platelet Activation Markers After Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction. American journal of therapeutics. 2015.
Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116(5):471-9.
Oshin O, Torella F. Low hemoglobin concentration is associated with poor outcome after peripheral arterial surgery. Vascular and endovascular surgery. 2013:1538574413493679.
Bertrand OF, Larose É, Rodés-Cabau J, Rinfret S, Déry J-P, Bagur R, et al. Incidence, range, and clinical effect of hemoglobin changes within 24 hours after transradial coronary stenting. The American journal of cardiology. 2010;106(2):155-61.
Kwok CS, Sherwood MW, Watson SM, Nasir SB, Sperrin M, Nolan J, et al. Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: a systematic review and meta-analysis. JACC: Cardiovascular Interventions. 2015;8(3):436-46.
Farahzadi M, Shafiee A, Bozorgi A, Mahmoudian M, Sadeghian S. Assessment of adherence to ACC/AHA guidelines in primary management of patients with NSTEMI in a referral cardiology hospital. Crit Pathw Cardiol. 2015;14(1):36-8.
Kassaian SE, Goodarzynejad H, Boroumand MA, Salarifar M, Masoudkabir F, Mohajeri-Tehrani MR, et al. Glycosylated hemoglobin (HbA1c) levels and clinical outcomes in diabetic patients following coronary artery stenting. Cardiovasc Diabetol. 2012;11(1):82.
Safarian H, Alidoosti M, Shafiee A, Salarifar M, Poorhosseini H, Nematipour E. The SYNTAX Score Can Predict Major Adverse Cardiac Events Following Percutaneous Coronary Intervention. Heart Views. 2014;15(4):99-105.
Kassaian S, Saroukhani S, Alaedini F, Salarifar M, Poorhosseini H, Lotfi-Tokaldani M, et al. A risk scoring model to predict in-hospital and one-year major adverse cardiac events after percutaneous coronary intervention. European Heart Journal. 2013;34(suppl 1):P4835.
Poorhosseini H, Mousavi M, Nematipour E, Kassaian SE, Salarifar M, Alidoosti M, et al. Success rate, procedural complications and clinical outcomes of coronary interventions in octogenarians: a case-control study. J Tehran Heart Cent. 2011;6(3):126-33.
Dunkelgrun M, Hoeks SE, Welten GM, Vidakovic R, Winkel TA, Schouten O, et al. Anemia as an independent predictor of perioperative and long-term cardiovascular outcome in patients scheduled for elective vascular surgery. The American journal of cardiology. 2008;101(8):1196-200.
Maluenda G, Lemesle G, Collins SD, Ben-Dor I, Syed AI, Torguson R, et al. The clinical significance of hematocrit values before and after percutaneous coronary intervention. American heart journal. 2009;158(6):1024-30.
Maluenda G, Lemesle G, Ben-Dor I, Collins SD, Syed AI, Li Y, et al. Value of blood transfusion in patients with a blood hematocrit of 24% to 30% after percutaneous coronary intervention. The American journal of cardiology. 2009;104(8):1069-73.