Impact of anemia on long‐term outcomes after percutaneous coronary intervention for chronic total occlusion

Stähli, Barbara E.; Gebhard, Cathérine; Gick, Michael; Ferenc, Mirosław; Mashayekhi, Kambis; Buettner, Heinz Joachim; Neumann, Franz‐Josef; Toma, Aurel

doi:10.1002/ccd.27412

Cited by 7 publications

(9 citation statements)

References 49 publications

(80 reference statements)

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“…Preprocedural anemia has been associated with a higher incidence of adverse follow‐up outcomes in patients undergoing elective PCI or PCI for ACS 1–7 . However, the effect of anemia on follow‐up outcomes after CTO PCI has only been evaluated in one study 8 that showed higher follow‐up MACE (hazard ratio [HR]: 1.26; 95% CI: 1.02–1.55; p = 0.03) and all‐cause mortality (HR: 2.26; 95% CI: 1.71–2.98; p < 0.001) in anemic patients, similar to our study (Figures 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Approximately 15%-17% of patients undergoing CTO PCI are anemic. 6,8 In a previous singlecenter study on 1964 patients undergoing CTO PCI, anemic patients had higher adjusted mortality during follow-up. 8 However, these findings have not been replicated in larger, multicenter cohorts.…”

Section: Introductionmentioning

confidence: 98%

“…6,8 In a previous singlecenter study on 1964 patients undergoing CTO PCI, anemic patients had higher adjusted mortality during follow-up. 8 However, these findings have not been replicated in larger, multicenter cohorts. We, therefore, examined the impact of anemia on the outcomes of CTO PCI in a large, multicenter CTO registry.…”

Section: Introductionmentioning

confidence: 98%

“…Anemia is common among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) 1–4 or elective procedures 5–7 and has been associated with a higher incidence of adverse outcomes 1–7 . Approximately 15%–17% of patients undergoing CTO PCI are anemic 6,8 . In a previous single‐center study on 1964 patients undergoing CTO PCI, anemic patients had higher adjusted mortality during follow‐up 8 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of preprocedural anemia on in‐hospital and follow‐up outcomes of chronic total occlusion percutaneous coronary intervention

Rempakos,

Kostantinis,

Simsek

et al. 2023

Cathet Cardio Intervent

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BackgroundThe impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 8633 CTO PCIs performed at 39 US and non‐US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of <13 g/dL in men and <12 g/dL in women.ResultsAnemia was present in 1652 (19%) patients undergoing CTO PCI. Anemic patients had a higher incidence of comorbidities, such as diabetes mellitus, hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease. CTOs in anemic patients were more likely to have complex angiographic characteristics, including smaller diameter, longer length, moderate to severe calcification, and moderate to severe proximal tortuosity. Anemic patients required longer procedure (119 vs. 107 min; p < 0.001) and fluoroscopy (45 vs. 40 min; p < 0.001) times but received similar contrast volumes. Technical success was similar between the two groups. In‐hospital major adverse cardiac events (MACE) rates were higher in patients with anemia; however, this association was no longer significant after adjusting for confounding factors. Baseline anemia was independently associated with follow‐up MACE (adjusted hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.07–2.49; p = 0.023) and all‐cause mortality (adjusted HR: 3.03; 95% CI: 1.41–6.49; p = 0.004).ConclusionsPreprocedural anemia is associated with more comorbidities, higher lesion complexity, longer procedure times, and higher follow‐up MACE and mortality after CTO PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Impact of preprocedural anemia on in‐hospital and follow‐up outcomes of chronic total occlusion percutaneous coronary intervention

Rempakos,

Kostantinis,

Simsek

et al. 2023

Cathet Cardio Intervent

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“…Several important prognostic factors, such as reduced left ventricular ejection fraction [11], anemia [12], and hemodialysis [13], have been identified, albeit the prognostic benefit of successful CTO-PCI does not differ according to the presence or absence of these prognostic factors. These factors are helpful in identifying high-risk patients who require close clinical follow-up and/or aggressive risk factor modification.…”

Section: Introductionmentioning

confidence: 99%

Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Nakatani¹,

Kohsaka

Yamane

et al. 2020

JCM

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Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.

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Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention

Kim

Hong

et al. 2019

The American Journal of Cardiology

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Impact of anemia on long‐term outcomes after percutaneous coronary intervention for chronic total occlusion

Abstract: Although anemia is associated with an increased all-cause mortality in patients undergoing CTO PCI, the survival benefit associated with successful CTO recanalization is maintained.

Cited by 7 publications

References 49 publications

Impact of preprocedural anemia on in‐hospital and follow‐up outcomes of chronic total occlusion percutaneous coronary intervention

Impact of preprocedural anemia on in‐hospital and follow‐up outcomes of chronic total occlusion percutaneous coronary intervention

Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention

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