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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1429900

Implications of Anemia on Patients Undergoing PCI with Impella-Support Insights From the PROTECT III Study

Provisionally accepted
Batla Falah Batla Falah 1Björn Redfors Björn Redfors 1,2,3Duzhi Zhao Duzhi Zhao 1Aditya S. Bharadwaj Aditya S. Bharadwaj 4Mir B. Basir Mir B. Basir 5Julia B. Thompson Julia B. Thompson 1Rajan A. Patel Rajan A. Patel 6Michael J. Schonning Michael J. Schonning 1Arsalan Abu-Much Arsalan Abu-Much 1Yiran Zhang Yiran Zhang 1Wayne B. Batchelor Wayne B. Batchelor 7Cindy L. Grines Cindy L. Grines 8William W. O'Neill William W. O'Neill 9*
  • 1 Cardiovascular Research Foundation, New York, New York, United States
  • 2 Division of Cardiology, New York Presbyterian Hospital, New York, United States
  • 3 Sahlgrenska University Hospital, Gothenburg, Sweden
  • 4 Loma Linda University, Loma Linda, California, United States
  • 5 Henry Ford Health System, Detroit, Michigan, United States
  • 6 Ochsner Medical Center, New Orleans, Louisiana, United States
  • 7 Inova Heart and Vascular Institute, Virginia, Minnesota, United States
  • 8 Northside Hospital Cardiovascular Institute, Atlanta, United States
  • 9 Henry Ford Hospital, Detroit, United States

The final, formatted version of the article will be published soon.

    Background:Anemia is prevalent among patients with cardiovascular disease and is associated with adverse outcomes. However, data regarding the impact of anemia in high-risk percutaneous coronary intervention (HRPCI) are limited.To evaluate the impact of anemia in patients undergoing Impella-supported HRPCI in the PROTECT-III study.Methods:Patients undergoing Impella-supported HRPCI in the multi-center PROTECT III study were assessed for anemia based on baseline hemoglobin levels according to World Health Organization criteria. Patients were stratified into three groups: no anemia, mild anemia, and moderate or severe anemia. Major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days, and major bleeding events were compared across groups.Results:Of 1071 patients with baseline hemoglobin data, 37.9% had no anemia, 43.4% had mild anemia, and 18.7% had moderate or severe anemia. Anemic patients were older and more likely to have comorbidities. Anemia was associated with higher MACCE rates at 30d (moderate to severe: 12.3%, mild: 9.8%, no anemia: 5.4%; p = 0.02) and at 90d (moderate to severe: 18.7%, mild: 14.6%, none: 8.3%; p = 0.004). These differences persisted after adjustment for potential confounders at 30 and 90d and sensitivity analysis excluding dialysis showed similar results.Major bleeding at 30d was also higher in anemic patients (5.5% vs. 1.2%, p = 0.002).Baseline anemia in Impella-supported HRPCI is common, and independently associated with MACCE and major bleeding, emphasizing its significance as a prognostic factor. Specific management strategies to reduce anemia-associated MACCE risk after HRPCI should be examined.

    Keywords: high-risk percutaneous coronary intervention, Anemia, Dialysis, Major adverse cardiovascular and cerebrovacular event, bleeding

    Received: 08 May 2024; Accepted: 01 Jul 2024.

    Copyright: © 2024 Falah, Redfors, Zhao, Bharadwaj, Basir, Thompson, Patel, Schonning, Abu-Much, Zhang, Batchelor, Grines and O'Neill. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: William W. O'Neill, Henry Ford Hospital, Detroit, United States

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