Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

Abstract

Although baseline hemoglobin and renal function are both important predictors of adverse outcomes after percutaneous coronary intervention (PCI), scarce data exist regarding the combined impact of these factors on outcomes. We sought to investigate the impact and threshold value of the hemoglobin to creatinine (Hgb/Cr) ratio, on in-hospital adverse outcomes among non-dialysis patients in a Japanese nationwide registry. We analyzed 157,978 non-dialysis patients who underwent PCI in 884 Japanese medical institutions in 2017. We studied differences in baseline characteristics and in-hospital clinical outcomes among four groups according to their quartiles of the Hgb/Cr ratios. Compared with patients with higher Hgb/Cr ratios, patients with lower ratios were older and had more comorbidities and complex coronary artery disease. Patients with lower hemoglobin and higher creatinine levels had a higher rate of in-hospital adverse outcomes including in-hospital mortality and procedural complications (defined as occurrence of cardiac tamponade, cardiogenic shock after PCI, emergency operation, or bleeding complications that required blood transfusion). On multivariate analyses, Hgb/Cr ratio was inversely associated with in-hospital mortality (odds ratio: 0.91, 95% confidence interval: 0.89–0.92; p < 0.001) and bleeding complications (odds ratio: 0.92, 95% confidence interval: 0.90–0.94; p < 0.001). Spline curve analysis demonstrated that these risks started to increase when the Hgb/Cr ratio was <15, and elevated exponentially when the ratio was <10. Hgb/Cr ratio is a simple index among non-dialysis patients and is inversely associated with in-hospital mortality and bleeding complications after PCI.

Analysis of the Correlation Between the Ratio of Monocytes to High-Density Lipoprotein Cholesterol and in-Stent Restenosis in Patients with Premature Coronary Heart Disease

“…Moreover, activation of sympathetic nerves and the renin-angiotensin-aldosterone system, chronic inflammation oxidative stress, and endothelial dysfunction may also be associated with high levels of creatinine. 23 Multivariate logistic regression analysis showed that serum creatinine and UA are not independent risk factors for ISR in PCHD. These findings may be attributable to the patients we selected, and we will include more patients in the future to improve our research.…”

Overview of in‐hospital outcomes in patients undergoing percutaneous coronary intervention with the revived directional coronary atherectomy

“…We extracted patient‐based data from the prospectively ongoing J‐PCI registry for the present study. The overview of this Japanese nationwide PCI registry has been previously published in detail 15–17 . Briefly, the J‐PCI registry is a prospective, multicenter, nationwide database of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) and is designed to record patients' characteristics, procedural data, and clinical outcomes after PCI.…”

Impact of serum haemoglobin-to-creatinine ratio after transcatheter aortic valve implantation

“… 21 22 Furthermore, Numasawa et al reported that the combined haemoglobin and renal function index was correlated with the short-term prognosis of patients undergoing percutaneous coronary intervention. 6 Therefore, we speculate that renal function combined with anaemia would be a strong prognostic factor in patients undergoing TAVI.…”

“… 4 5 A combined anaemia and renal failure index have been reported to be associated with adverse outcomes following percutaneous coronary intervention. 6 This study aimed to determine the predictive accuracy of a combined anaemia and renal failure index for predicting the 1-year prognosis of patients undergoing TAVI.…”