Additive Effect of Anemia and Renal Impairment on Long-Term Outcome after Percutaneous Coronary Intervention

作者：Pilgrim Thomas^*; Rothenbuehler Martina; Kalesan Bindu; Pulver Cedric; Stefanini Giulio G; Zanchin Thomas; Raeber Lorenz; Stortecky Stefan; Jung Simon; Mattle Heinrich; Moschovitis Aris; Wenaweser Peter; Meier Bernhard; Gsponer Thomas; Windecker Stephan; Juenl Peter

来源：PLos One, 2014, 9(12): e114846.

DOI：10.1371/journal.pone.0114846

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. %26lt;br%26gt;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 %26lt;120 g/l and %26lt;130 g/l, for women and men, respectively) and renal impairment (creatinine clearance,60 ml/min) at baseline. %26lt;br%26gt;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. %26lt;br%26gt;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.

• 出版日期2014-12-9