Heart and Vessels

, Volume 22, Issue 6, pp 383–388

Impact of anemia on nonfatal coronary events after percutaneous coronary interventions

  • Alp Burak Catakoglu
  • Saide Aytekin
  • Murat Sener
  • Hilal Kurtoglu
  • Huseyin Celebi
  • I.C. Cemsid Demiroglu
  • Vedat Aytekin


Anemia is associated with higher rates of cardiovascular events in patients with heart failure, acute myocardial infarction, and in patients undergoing coronary artery bypass graft surgery. Although studies have focused on fatal coronary events in anemic patients following percutaneous coronary intervention (PCI), data is lacking regarding nonfatal coronary events. The aim of our study was to analyze the incidence of anemia in patients who developed nonfatal events after successful PCI, and to make a comparison with event-free patients. Forty-nine consecutive patients with and 51 without nonfatal coronary events (nonfatal myocardial infarction, coronary artery bypass grafting, or repeat PCI) during the 1-year follow-up after the index PCI procedure were included in the study. Anemia was defined using World Health Organization (WHO) criteria as a hematocrit value at initial presentation <39% for men and <36% for women. Baseline hematocrit levels were measured before the procedure. Baseline clinical, lesion, and procedural characteristics were comparable in both groups. Anemia was present in 33.8% of men and 30.4% of women. The incidence of anemia in patients with nonfatal coronary events was 46.9% and 15.7% in the event-free group, which was significantly different (P = 0.001). Anemia was found to be an independent risk factor for nonfatal coronary events in PCI patients (odds ratio: 2.24, 95% confidence interval: 1.05–4.79; P = 0.036). In conclusion, anemia is an important risk factor for predicting nonfatal coronary events after PCI. Although previous studies have shown its impact on fatal events, this study has demonstrated that anemia also has a role in nonfatal thrombotic coronary events and restenosis.

Key words

Percutaneous coronary intervention Anemia Adverse coronary event 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    DeFoe, GR, Ross, CS, Olmstead, EM, Surgenor, SD, Fillinger, MP, Groom, RC, Forest, RJ, Pieroni, JW, Warren, CS, Bogosian, ME, Krumholz, CF, Clark, C, Clough, RA, Weldner, PW, Lahey, SJ, Leavitt, BJ, Marrin, CA, Charlesworth, DC, Marshall, P, O'Connor, GT 2001Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study GroupAnn Thorac Surg71769776PubMedCrossRefGoogle Scholar
  2. 2.
    Ezekowitz, JA, McAlister, FA, Armstrong, PW 2003Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failureCirculation107223225PubMedCrossRefGoogle Scholar
  3. 3.
    Wu, WC, Rathore, SS, Wang, Y, Radford, MJ, Krumholz, HM 2001Blood transfusion in elderly patients with acute myocardial infarctionN Engl J Med34512301236PubMedCrossRefGoogle Scholar
  4. 4.
    Zindrou, D, Taylor, KM, Bagger, JP 2002Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgeryLancet35917471748PubMedCrossRefGoogle Scholar
  5. 5.
    Smith, SC,Jr, Dove, JT, Jacobs, AK, Kennedy, JW, Kereiakes, D, Kern, MJ, Kuntz, RE, Popma, JJ, Schaff, HV, Williams, DO, Gibbons, RJ, Alpert, JP, Eagle, KA, Faxon, DP, Fuster, V, Gardner, TJ, Gregoratos, G, Russell, RO, Smith, SC,Jr 2001ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty)J Am Coll Cardiol3722152239PubMedCrossRefGoogle Scholar
  6. 6.
    Topol, EJ 2003

    Elective coronary intervention: approach, technique, and complications

    Topol, EJ eds. Textbook of interventional cardiology4th ednSaundersPhiladelphia1123
    Google Scholar
  7. 7.
    WHO1968Nutritional Anemias. Report of a WHO Scientific GroupWorld Health OrganizationGenevaGoogle Scholar
  8. 8.
    Levey, AS, Bosch, JP, Lewis, JB, Greene, T, Rogers, N, Roth, D 1999A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study GroupAnn Intern Med130461470PubMedGoogle Scholar
  9. 9.
    Dries, DL, Exner, DV, Domanski, MJ, Greenberg, B, Stevenson, LW 2000The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunctionJ Am Coll Cardiol35681689PubMedCrossRefGoogle Scholar
  10. 10.
    Carson, JL, Duff, A, Poses, RM, Berlin, JA, Spence, RK, Trout, R, Noveck, H, Strom, BL 1996Effect of anaemia and cardiovascular disease on surgical mortality and morbidityLancet34810551060PubMedCrossRefGoogle Scholar
  11. 11.
    Czer, LS, Shoemaker, WC 1978Optimal hematocrit value in critically ill postoperative patientsSurg Gynecol Obstet147363368PubMedGoogle Scholar
  12. 12.
    Hebert, PC, Wells, G, Blajchman, MA, Marshall, J, Martin, C, Pagliarello, G, Tweeddale, M, Schweitzer, I, Yetisir, E 1999A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials GroupN Engl J Med340409417PubMedCrossRefGoogle Scholar
  13. 13.
    Hebert, PC, Wells, G, Tweeddale, M, Martin, C, Marshall, J, Pham, B, Blajchman, M, Schweitzer, I, Pagliarello, G 1997Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials GroupAm J Respir Crit Care Med15516181623PubMedGoogle Scholar
  14. 14.
    Horwich, TB, Fonarow, GC, Hamilton, MA, MacLellan, WR, Borenstein, J 2002Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failureJ Am Coll Cardiol3917801786PubMedCrossRefGoogle Scholar
  15. 15.
    Pedersen, TR Kjekshus, J Berg, K Haghfelt, T Faergeman, O Faergeman, G Pyorala, K Miettinen, T Wilhelmsen, L Olsson, AG Wedel, H Scandinavian Simvastatin Survival Study Group1994Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)Lancet34413831389CrossRefGoogle Scholar
  16. 16.
    HOPE study investigators1996The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. The HOPE study investigatorsCan J Cardiol12127137Google Scholar
  17. 17.
    Veselka, J, Prochazkova, S, Duchonova, R, Homolova, I, Tesar, D, Bybee, KA 2006Preprocedural statin therapy reduces the risk and extent of cardiac biomarker release following percutaneous coronary interventionHeart Vessels21146151PubMedCrossRefGoogle Scholar
  18. 18.
    Watanabe, I, Nagao, K, Tani, S, Masuda, N, Yahata, T, Ohguchi, S, Kanmatsuse, K, Kushiro, T 2006Reperfusion strategy for acute myocardial infarction in elderly patients aged 75 to 80 yearsHeart Vessels21236241PubMedCrossRefGoogle Scholar
  19. 19.
    Sarnak, MJ, Tighiouart, H, Manjunath, G, MacLeod, B, Griffith, J, Salem, D, Levey, AS 2002Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) studyJ Am Coll Cardiol402733PubMedCrossRefGoogle Scholar
  20. 20.
    Dillmann, E, Johnson, DG, Martin, J, Mackler, B, Finch, C 1979Catecholamine elevation in iron deficiencyAm J Physiol237R297R300PubMedGoogle Scholar
  21. 21.
    Takahashi, M, Kurokawa, S, Tsuyusaki, T, Kikawada, R 1990[Studies of hyperkinetic circulatory state in chronic anemia]J Cardiol20331339PubMedGoogle Scholar
  22. 22.
    McMahon, TJ, Moon, RE, Luschinger, BP, Carraway, MS, Stone, AE, Stolp, BW, Gow, AJ, Pawloski, JR, Watke, P, Singel, DJ, Piantadosi, CA, Stamler, JS 2002Nitric oxide in the human respiratory cycleNat Med8711717PubMedGoogle Scholar
  23. 23.
    Mann, JF 1999What are the short-term and long-term consequences of anaemia in CRF patients?Nephrol Dial Transplant142936PubMedCrossRefGoogle Scholar
  24. 24.
    Hill, JM, Zalos, G, Halcox, JP, Schenke, WH, Waclawiw, MA, Quyyumi, AA, Finkel, T 2003Circulating endothelial progenitor cells, vascular function, and cardiovascular riskN Engl J Med348593600PubMedCrossRefGoogle Scholar
  25. 25.
    Orlic, D, Kajstura, J, Chimenti, S, Jakoniuk, I, Anderson, SM, Li, B, Pickel, J, McKay, R, Nadal-Ginard, B, Bodine, DM, Leri, A, Anversa, P 2001Bone marrow cells regenerate infarcted myocardiumNature410701705PubMedCrossRefGoogle Scholar
  26. 26.
    Anderson, HV, Shaw, RE, Brindis, RG, Hewitt, K, Krone, RJ, Block, PC, McKay, CR, Weintraub, WS 2002A contemporary overview of percutaneous coronary interventions. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)J Am Coll Cardiol3910961103PubMedCrossRefGoogle Scholar
  27. 27.
    Holmes, DR, Selzer, F, Johnston, JM, Kelsey, SF, Holubkov, R, Cohen, HA, Williams, DO, Detre, KM 2003Modeling and risk prediction in the current era of interventional cardiology: a report from the National Heart, Lung, and Blood Institute Dynamic RegistryCirculation10718711876PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Alp Burak Catakoglu
    • 1
  • Saide Aytekin
    • 2
  • Murat Sener
    • 2
  • Hilal Kurtoglu
    • 2
  • Huseyin Celebi
    • 1
  • I.C. Cemsid Demiroglu
    • 1
  • Vedat Aytekin
    • 2
  1. 1.Department of CardiologyFlorence Nightingale HospitalIstanbulTurkey
  2. 2.Department of Cardiology, Istanbul Bilim UniversityFlorence Nightingale HospitalIstanbulTurkey

Personalised recommendations