Copyright © 2003 by the European Society of Cardiology.
Clinical research
Haemoglobin-related mortality in patients undergoing percutaneous coronary interventions
a Medizinische Klinik und Poliklinik C (Department of Cardiology and Angiology), Hospital of the University of Münster, Münster, Germany
b Institut für Epidemiologie und Sozialmedizin (Institute for Epidemiology und Social Medicine), Hospital of the University of Münster, Münster, Germany
c Institut für Klinische Chemie und Laboratoriumsmedizin (Institute of Clinical Chemistry and Laboratory Medicine), Hospital of the University of Münster, Münster, Germany
d Medizinische Klinik und Poliklinik D (Department of Nephrology), Hospital of the University of Münster, Münster, Germany
e Department of Biochemistry, Southwestern Medical Center, Dallas, USA
* Correspondence to: Dr H. Reinecke, Medizinische Klinik und Poliklinik C, Universitätsklinikum Münster, D-48129 Münster, Germany. Tel: +49 251 834 7617; Fax: +49 251 834 7864
E-mail address: reinech{at}uni-muenster.de
Received 7 February 2003; revised 16 July 2003; accepted 11 September 2003
Abstract
Aims It has recently been proposed that anaemia is an independent risk factor for development of cardiovascular disease in the general population. The impact of anaemia on long-term survival of patients with manifest coronary heart disease (CHD) has not been assessed so far. In this study, we examined the influence of haemoglobin concentrations on the outcome after percutaneous coronary interventions (PCI).
Methods and results In a retrospective cohort study, we analysed in-hospital and long-term mortality in all male patients admitted to our institution for elective PCI from 1998 to 1999. In 689 cases, complete follow-up information could be obtained (98.4%). Depending on their baseline haemoglobin, patients were divided in quintiles. In all subgroups, angiographic success after PCI (90–94%) was comparably high and in-hospital mortality was low (0–0.7%). During follow-up (median 697 days), patients in the lowest haemoglobin quintile (
12.9g/dl) were significantly more likely to suffer from all-cause death (22.2%) than those of the other quintiles (3.7–12.1%; estimated mortality rates from Kaplan–Meier models, P<0.0001, log rank test). In more detail, we found a U-shaped relationship between mortality and haemoglobin strata in steps of 1g/dl (P<0.0001, log rank test). After adjustment for potential co-variates, patients of the lowest haemoglobin quintile showed in Cox regression analysis a markedly higher risk for death (adjusted hazard rate ratio (HRR) 4.09, 95% confidence interval (CI) 1.52–11.05) compared to the quintile with a haemoglobin concentration of 14.6–15.2g/dl.
Conclusion These results indicate that anaemia is associated with markedly reduced survival in patients with CHD after elective PCI. Since PCI is a common intervention and anaemia is a frequent condition in the general population, strategies for the management of anaemic PCI patients and treatment of anaemic patients with CHD should be developed.
Key Words: Anaemia • Angioplasty • Percutaneous coronaryintervention • Mortality
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