Abstract 719 Title: Hemoglobin drop in addition to anaemia increases long-term mortality in patients following percutaneous coronary intervention

Background: Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. In addition, recent studies demonstrated the link of a hemoglobin (Hb) drop on with impaired prognosis after percutaneous coronary interventions. We aimed to determine the complemental association of anemia and Hb drop with long-term survival in a longitudinal registry of patients following percutaneous coronary intervention.

Methods: The present analysis is based on the ECAD registry of patients with CAD undergoing conventional coronary angiography and receiving percutaneous coronary interventions (PCI) at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of <13.0g/dl for male and <12.0g/dl for female patients according to the world health organization’s definition. Hb drop was defined as a decrease in Hb levels of ≥2g/dl during index hospitalization. Cox regression analysis was used to determine the association of anemia and Hb drop with morality, adjusting for age, sex, systolic blood pressure, LDL-cholesterol, diabetes, smoking status, positive family history of premature CAD, discharge diagnosis, P2Y12-therapy, oral anticoagulation therapy, and left main disease. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia and Hb drop.

Results: Overall, data from 8970 patients (mean age: 66.0±11.5 years, 76.1% male) were included in our analysis (6503 patients without and 2467 patients with anemia, 7737 patient without and 1233 with Hb drop). We observed a stepwise increase in mortality rates with presence of anemia, Hb drop or boths as compared to patients without anemia or Hb drop (p<0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.9-fold increased mortality risk (2.87 [2.57-3.20], p<0.0001). Effect sizes remained stable upon adjustment for traditional risk factors, medication and clinical characteristics (2.38 [2.18-2.61], p<0.0001). For patients with Hb drop, we observed a 2.3-fold increased mortality risk in multivariable analysis (2.05-2.65, p<0.0001). The presence of both anemia and Hb drop was associated with worst outcome (2.80 [2.50-3.14], p<0.0001). Mortality risk accountable to patients with anemia and Hb drop in acute coronary syndrome (ACS) was higher as compared to patients with chronic coronary syndromes (3.47 [2.83-4.24], p<0.0001 vs. 3.0 [2.63-3.43], p<0.0003).

Conclusion: In this large registry of patients undergoing percutaneous coronary intervention, anemia and Hb drop are complementary associated with impaired long-term survival. Further studies are needed to define optimal antithrombotic and anticoagulation strategies in this high risk cohort

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Title: Hemoglobin drop in addition to anaemia increases long-term mortality in patients following percutaneous coronary intervention – The ECAT registry
B. Balcer¹, S. Hendricks¹, I. Dykun¹, M. Totzeck¹, T. Rassaf¹, A.-A. Mahabadi¹
¹Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen;
Background: Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. In addition, recent studies demonstrated the link of a hemoglobin (Hb) drop on with impaired prognosis after percutaneous coronary interventions. We aimed to determine the complemental association of anemia and Hb drop with long-term survival in a longitudinal registry of patients following percutaneous coronary intervention. Methods: The present analysis is based on the ECAD registry of patients with CAD undergoing conventional coronary angiography and receiving percutaneous coronary interventions (PCI) at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of <13.0g/dl for male and <12.0g/dl for female patients according to the world health organization’s definition. Hb drop was defined as a decrease in Hb levels of ≥2g/dl during index hospitalization. Cox regression analysis was used to determine the association of anemia and Hb drop with morality, adjusting for age, sex, systolic blood pressure, LDL-cholesterol, diabetes, smoking status, positive family history of premature CAD, discharge diagnosis, P2Y12-therapy, oral anticoagulation therapy, and left main disease. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia and Hb drop. Results: Overall, data from 8970 patients (mean age: 66.0±11.5 years, 76.1% male) were included in our analysis (6503 patients without and 2467 patients with anemia, 7737 patient without and 1233 with Hb drop). We observed a stepwise increase in mortality rates with presence of anemia, Hb drop or boths as compared to patients without anemia or Hb drop (p<0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.9-fold increased mortality risk (2.87 [2.57-3.20], p<0.0001). Effect sizes remained stable upon adjustment for traditional risk factors, medication and clinical characteristics (2.38 [2.18-2.61], p<0.0001). For patients with Hb drop, we observed a 2.3-fold increased mortality risk in multivariable analysis (2.05-2.65, p<0.0001). The presence of both anemia and Hb drop was associated with worst outcome (2.80 [2.50-3.14], p<0.0001). Mortality risk accountable to patients with anemia and Hb drop in acute coronary syndrome (ACS) was higher as compared to patients with chronic coronary syndromes (3.47 [2.83-4.24], p<0.0001 vs. 3.0 [2.63-3.43], p<0.0003). Conclusion: In this large registry of patients undergoing percutaneous coronary intervention, anemia and Hb drop are complementary associated with impaired long-term survival. Further studies are needed to define optimal antithrombotic and anticoagulation strategies in this high risk cohort Figure 1: Kaplan Meier analysis for the survival of patients undergoing conventional coronary angiography with no Hb drop and no anemia (blue), with no Hb drop but anemia (red), with Hb drop but no anemia (green) and with Hb drop and anemia (brown), demonstrating a significantly higher all-cause mortality in patients with anemia and Hb drop.
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