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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.
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      References

        • Tsujita K.
        • Nikolsky E.
        • Lansky A.J.
        • Dangas G.
        • Fahy M.
        • Brodie B.R.
        • Dudek D.
        • Mockel M.
        • Ochala A.
        • Mehran R.
        • Stone G.W.
        Impact of anemia on clinical outcomes of patients with ST-segment elevation myocardial infarction in relation to gender and adjunctive antithrombotic therapy (from the HORIZONS-AMI trial).
        Am J Cardiol. 2010; 105: 1385-1394
        • Voeltz M.D.
        • Patel A.D.
        • Feit F.
        • Fazel R.
        • Lincoff A.M.
        • Manoukian S.V.
        Effect of anemia on hemorrhagic complications and mortality following percutaneous coronary intervention.
        Am J Cardiol. 2007; 99: 1513-1517
        • Nikolsky E.
        • Aymong E.D.
        • Halkin A.
        • Grines C.L.
        • Cox D.A.
        • Garica E.
        • Mehran R.
        • Tcheng J.E.
        • Griffin J.J.
        • Guagliumi G.
        • Stuckey T.
        • Turco M.
        • Cohen D.A.
        • Negoita M.
        • Lansky A.J.
        • Stone G.W.
        Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial.
        J Am Coll Cardiol. 2004; 44: 547-553
        • Kim T.H.
        • Koh Y.S.
        • Chang K.
        • Seo S.M.
        • Kim C.J.
        • Park H.J.
        • Kim P.J.
        • Her S.H.
        • Kim D.B.
        • Lee J.M.
        • Park C.S.
        • Kim H.Y.
        • Yoo K.D.
        • Jeon D.S.
        • Park J.H.
        • CHung W.S.
        • Seugn K.B.
        Improved anemia is associated with favorable long-term clinical outcomes in patients undergoing PCI.
        Coron Artery Dis. 2012; 23: 391-399
        • Kitai Y.
        • Ozasa N.
        • Morimoto T.
        • Bao B.
        • Furukawa Y.
        • Nakagawa Y.
        • Kadota K.
        • Yanagita M.
        • Shizuta S.
        • Kimura T.
        Prognostic implications of anemia with or without chronic kidney disease in patients undergoing elective percutaneous coronary intervention.
        Int J Cardiol. 2013; 168: 5221-5228
        • Dundar C.
        • Oduncu V.
        • Erkol A.
        • Tanalp A.C.
        • Sirma D.
        • Karagoz A.
        • Karabay C.Y.
        • Kilicgedik A.
        • Pala S.
        • Tigen K.
        • Izqi A.
        • Kirma C.
        In-hospital prognostic value of hemoglobin levels on admission in patients with acute ST segment elevation myocardial infarction undergoing primary angioplasty.
        Clin Res Cardiol. 2012; 101: 37-44
        • Nikolsky E.
        • Mehran R.
        • Aymong E.D.
        • Mintz G.S.
        • Lansky A.J.
        • Lasic Z.
        • Negoita M.
        • Fahy M.
        • Pocock S.J.
        • Na Y.
        • Krieger S.
        • Moses J.W.
        • Stone G.W.
        • Leon M.B.
        • Dangas G.
        Impact of anemia on outcomes of patients undergoing percutaneous coronary interventions.
        Am J Cardiol. 2004; 94: 1023-1027
        • Pilgrim T.
        • Vetterli F.
        • Kalesan B.
        • Stefanini G.G.
        • Raber L.
        • Stortecky S.
        • Gloekler S.
        • Binder R.K.
        • Wenaweser P.
        • Moschovitis A.
        • Khattab A.A.
        • Buellesfeld L.
        • Zwahlen M.
        • Meier B.
        • Juni P.
        • Windecker S.
        The impact of anemia on long-term clinical outcome in patients undergoing revascularization with the unrestricted use of drug-eluting stents.
        Circ Cardiovasc Interv. 2012; 5: 202-210
        • Maluenda G.
        • Lemesle G.
        • Collins S.D.
        • Ben-Dor I.
        • Syed A.I.
        • Torguson R.
        • Kaneshige K.
        • Xue Z.
        • Pakala R.
        • Suddath W.O.
        • Satler L.F.
        • Kent K.M.
        • Lindsay J.
        • Pichard A.D.
        • Waksman R.
        The clinical significance of hematocrit values before and after percutaneous coronary intervention.
        Am Heart J. 2009; 158: 1024-1030
        • Hosseini S.K.
        • Ansari M.J.
        • Lotfi Tokaldany M.
        • Sharafi A.
        • Hakki Kazazi E.
        • Poorhosseini H.
        Association between preprocedural hemoglobin level and 1-year outcome of elective percutaneous coronary intervention.
        J Cardiovasc Med. 2014; 15: 331-335
        • Lee P.C.
        • Kini A.S.
        • Ahsan C.
        • Fisher E.
        • Sharma S.K.
        Anemia is an independent predictor of mortality after percutaneous coronary intervention.
        J Am Coll Cardiol. 2004; 44: 541-546
        • Valente S.
        • Lazzeri C.
        • Chiostri M.
        • Sori A.
        • Giglioli C.
        • Gensini G.F.
        Prior and new onset anemia in ST-elevation myocardial infarction: a different prognostic role?.
        Intern Emerg Med. 2011; 6: 329-336
        • Poludasu S.
        • Marmur J.D.
        • Weedon J.
        • Khan W.
        • Cavusoglu E.
        Effect of hemoglobin level on long-term all-cause mortality after percutaneous coronary intervention in African-Americans.
        Am J Cardiol. 2009; 103: 1078-1082
        • Matsue Y.
        • Matsumura A.
        • Abe M.
        • Ono M.
        • Seya M.
        • Nakamura T.
        • Iwatsuka R.
        • Mizukami A.
        • Setoguchi M.
        • Nagahori W.
        • Ohno M.
        • Suzuki M.
        • Hashimoto Y.
        Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients.
        Heart Vessels. 2013; 28: 19-26
        • Manzano-Fernandez S.
        • Marin F.
        • Martinez J.A.
        • Cambronero F.
        • Valdes M.
        • Ruiz-Nodar J.M.
        • Perez-Berbel P.
        • Lip G.Y.
        Anemia as predictor of gastrointestinal bleeding in atrial fibrillation patients undergoing percutaneous coronary artery stenting.
        QJM. 2008; 101: 749-751
        • Halkin A.
        • Singh M.
        • Nikolsky E.
        • Grines C.L.
        • Tcheng J.E.
        • Garcia E.
        • Cox D.A.
        • Turco M.
        • Stuckey T.D.
        • Na Y.
        • Lansky A.J.
        • Gersh B.J.
        • O'Neill W.W.
        • Mehran R.
        • Stone G.W.
        Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score.
        J Am Coll Cardiol. 2005; 45: 1397-1405
        • Rao S.V.
        • McCoy L.A.
        • Spertus J.A.
        • Krone R.J.
        • Singh M.
        • Gitzgerald S.
        • Peterson E.D.
        An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry.
        JACC Cardiovasc Interv. 2013; 6: 897-904
        • Mehta S.K.
        • Frutkin A.D.
        • Lindsey J.B.
        • House J.A.
        • Spertus J.A.
        • Rao S.V.
        • Ou F.S.
        • Roe M.T.
        • Peterson E.D.
        • Marso S.P.
        Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry.
        Circ Cardiovasc Interv. 2009; 2: 222-229
        • Rathod K.S.
        • Jones D.A.
        • Rathod V.S.
        • Bromage D.
        • Guttmann O.
        • Gallagher S.M.
        • Mohiddin S.
        • Rothman M.T.
        • Knight C.
        • Jain A.K.
        • Kapur A.
        • Mathur A.
        • Timmis A.D.
        • Amersey R.
        • Wragg A.
        Prognostic impact of anemia on patients with ST-elevation myocardial infarction treated by primary PCI.
        Coron Artery Dis. 2014; 25: 52-59
        • Ioannidis J.P.
        • Trikalinos T.A.
        The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey.
        CMAJ. 2010; 176: 1091-1096
        • Davies H.T.
        • Crombie I.K.
        • Tavakoli M.
        When can odds ratios mislead?.
        BMJ. 1998; 316: 989-991
        • Kwok C.S.
        • Rao S.V.
        • Myint P.K.
        • Keavney B.
        • Nolan J.
        • Ludman P.F.
        • de Belder M.A.
        • Loke Y.K.
        • Mamas M.A.
        Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis.
        Open Heart. 2014; 1: e000021
        • Hanna E.B.
        • Alexander K.P.
        • Chen A.Y.
        • Roe M.T.
        • Funk M.
        • Saucedo J.F.
        Characteristics and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction undergoing an invasive strategy according to hemoglobin levels.
        Am J Cardiol. 2013; 111: 1099-1103
        • Authors/Task Force Members
        • Windecker S.
        • Kolh P.
        • Alfonso F.
        • Collet J.P.
        • Cremer J.
        • Falk V.
        • Filippatos G.
        • Hamm C.
        • Head S.J.
        • Juni P.
        • appetein A.P.
        • Kastrati A.
        • Knuuti J.
        • Landmesser U.
        • Laufer G.
        • Neumann F.J.
        • Richter D.J.
        • Schauerte P.
        • Sousa Uva M.
        • Stefanini G.G.
        • Taggart D.P.
        • Torracca L.
        • Valvimigli M.
        • Wijns W.
        • Witkowski A.
        2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
        Eur Heart J. 2014; 35: 2541-2619
        • Urban P.
        • Meredith I.T.
        • Abizaid A.
        • Pocock S.J.
        • Carrie D.
        • Naber C.
        • Lipiecki J.
        • Richardt G.
        • Iniquez A.
        • Brunel P.
        • Valdes-Chavarri M.
        • Garot P.
        • Talwar S.
        • Berland J.
        • Abdellaoui M.
        • Eberli F.
        • Oldroyd K.
        • Zambahari R.
        • Gregson J.
        • Greene S.
        • Stoll H.P.
        • Morice M.C.
        Polymer-free drug-coated coronary stents in patients at high bleeding risk.
        New Engl J Med. 2015; 373: 2038-2047
        • Kwok C.S.
        • Sherwood M.W.
        • Watson S.M.
        • Nasir S.B.
        • Sperrin M.
        • Nolan J.
        • Kinnaird T.
        • Kiatchoosakun S.
        • Ludman P.F.
        • de Belder M.A.
        • Rao S.V.
        • Mamas M.A.
        Blood transfusion after percutaneous coronary intervention and risk of subsequent adverse outcomes: a systematic review and meta-analysis.
        JACC Cardiovasc Interv. 2015; 8: 436-446
        • Mamas M.A.
        • Fath-Ordoubadi F.
        • Danzi G.B.
        • Spaepen E.
        • Kwok C.S.
        • Buchan I.
        • Peek N.
        • de Belder M.A.
        • Ludman P.F.
        • Paunovic D.
        • Urban P.
        Prevalence and impact of co-morbidity burden as defined by the Charlson Co-morbidity Index on 30-day and 1- and 5-year outcomes after coronary stent implantation (from the Nobori-2 study).
        Am J Cardiol. 2015; 116: 364-371
        • Sherwood M.W.
        • Wang Y.
        • Curtis J.P.
        • Peterson E.D.
        • Rao S.V.
        Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention.
        JAMA. 2014; 311: 836-843
        • Carson J.L.
        • Brooks M.M.
        • Abbott J.D.
        • Chaitman B.
        • Kelsey S.F.
        • Triulzi D.J.
        • Srinivas V.
        • Menegus M.A.
        • Marroquin O.C.
        • Rao S.V.
        • Noveck H.
        • Passano E.
        • Hardison R.M.
        • Smitherman T.
        • vagonescu T.
        • Wimmer N.J.
        • William D.O.
        Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
        Am Heart J. 2013; 165 (e1): 964-971
        • Kwok C.S.
        • Khan M.A.
        • Rao S.V.
        • Kinnaird T.
        • Sperrin M.
        • Buchan I.
        • de Belder M.A.
        • Ludman P.F.
        • Nolan J.
        • Loke Y.K.
        • Mamas M.A.
        Access and non-access site bleeding after percutaneous coronary intervention and risk of subsequent mortality and major adverse cardiovascular events: systematic review and meta-analysis.
        Circ Cardiovasc Interv. 2015; 8https://doi.org/10.1161/CIRCINTERVENTIONS.114.001645