Abstract 1109: Combined Effect of Anemia and Bleeding on Long-Term Outcomes Following PCI With Drug-Eluting Stents in Real World Clinical Practice
Background: Anemia and post-PCI bleeding are associated with unfavorable clinical outcomes after percutaneous coronary interventions (PCI). However, it is unclear whether there is a combined effect of anemia and bleeding on long-term prognosis in current clinical practice of revascularization with drug-eluting stents (DES).
Methods: Using the 2004/2005 Cornell Angioplasty Registry, we studied 2,504 consecutive patients undergoing urgent or elective PCI. Anemia was defined as hemoglobin level (Hgb) ≤ 12g/dl; post-PCI bleeding was defined as a drop in Hgb ≥2 g/dl. We excluded patients presenting with an acute MI ≤24 hours, hemodynamic instability/shock, thrombolytic therapy ≤7 days, or renal insufficiency. Mean clinical follow-up was 24.8±7.7 months.
Results: Clinical outcomes are shown in the Table⇓. DES were used in 87% of PCI. Patients with baseline anemia and post-procedural bleeding had particularly poor short- and long-term outcomes. After multivariate Cox regression analysis, post-PCI bleeding in anemic patients (HR 2.5, 95%CI 1.2– 4.8, p=0.010) was an independent predictor of long-term all-cause mortality. After adjustment for baseline factors, bleeding in non-anemic patients was not independently predictive of late mortality (HR 1.5, 95% CI 0.8 –2.8, p=0.257).
Conclusions: The combination of anemia and bleeding confers additive unfavorable prognosis in patients undergoing PCI in current clinical practice with DES. At two years, anemic patients who bleed post-PCI have a much greater mortality compared to the other groups. If bleeding occurs post-PCI in patients with anemia, meticulous post-procedural scrutiny and medical management is warranted.