Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention

Pilgrim, Thomas; Rothenbühler, Martina; Kalesan, Bindu; Pulver, Cédric; Stefanini, Giulio G; Zanchin, Thomas; Räber, Lorenz; Stortecky, Stefan; Jung, Simon; Mattle, Heinrich; Moschovitis, Aris; Wenaweser, Peter Martin; Meier, Bernhard; Gsponer, Thomas; Windecker, Stephan; Jüni, Peter (2014). Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention. PLoS ONE, 9(12), e114846. Public Library of Science 10.1371/journal.pone.0114846

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INTRODUCTION Anemia and renal impairment are important co-morbidities among patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI). Disease progression to eventual death can be understood as the combined effect of baseline characteristics and intermediate outcomes. METHODS Using data from a prospective cohort study, we investigated clinical pathways reflecting the transitions from PCI through intermediate ischemic or hemorrhagic events to all-cause mortality in a multi-state analysis as a function of anemia (hemoglobin concentration <120 g/l and <130 g/l, for women and men, respectively) and renal impairment (creatinine clearance <60 ml/min) at baseline. RESULTS Among 6029 patients undergoing PCI, anemia and renal impairment were observed isolated or in combination in 990 (16.4%), 384 (6.4%), and 309 (5.1%) patients, respectively. The most frequent transition was from PCI to death (6.7%, 95% CI 6.1-7.3), followed by ischemic events (4.8%, 95 CI 4.3-5.4) and bleeding (3.4%, 95% CI 3.0-3.9). Among patients with both anemia and renal impairment, the risk of death was increased 4-fold as compared to the reference group (HR 3.9, 95% CI 2.9-5.4) and roughly doubled as compared to patients with either anemia (HR 1.7, 95% CI 1.3-2.2) or renal impairment (HR 2.1, 95% CI 1.5-2.9) alone. Hazard ratios indicated an increased risk of bleeding in all three groups compared to patients with neither anemia nor renal impairment. CONCLUSIONS Applying a multi-state model we found evidence for a gradient of risk for the composite of bleeding, ischemic events, or death as a function of hemoglobin value and estimated glomerular filtration rate at baseline.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Pilgrim, Thomas; Rothenbühler, Martina; Kalesan, Bindu; Stefanini, Giulio; Räber, Lorenz; Stortecky, Stefan; Jung, Simon; Mattle, Heinrich; Moschovitis, Aris; Wenaweser, Peter Martin; Meier, Bernhard; Gsponer, Thomas; Windecker, Stephan and Jüni, Peter

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

05 Jan 2015 16:43

Last Modified:

30 Nov 2017 13:51

Publisher DOI:

10.1371/journal.pone.0114846

PubMed ID:

25489846

Additional Information:

Pilgrim and Rothenbühler contributed equally to this work.

BORIS DOI:

10.7892/boris.61445

URI:

https://boris.unibe.ch/id/eprint/61445

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