Why the study?
Bleeding is associated with higher mortality after PCI in ACS, but whether hemoglobin reduction with or without clinical bleeding correlates with in-hospital mortality was undetermined.
Does a reduction in hemoglobin (>3 g/dL) with or without overt clinical bleeding increase in-hospital mortality in patients with ACS undergoing primary PCI?
Does a reduction in hemoglobin (>3 g/dL) with or without overt clinical bleeding increase in-hospital mortality in patients with ACS undergoing primary PCI?
A hemoglobin drop of >3 g/dL after PCI in ACS patients is strongly associated with increased in-hospital mortality, even in the absence of overt clinical bleeding.
Post-PCI hemoglobin reduction signals higher in-hospital mortality risk in ACS; hypothesis-generating and should not yet alter practice.
BACKGROUND: Bleeding events are associated with higher mortality rates in patients with cardiovascular diseases, including patients presenting with acute coronary syndrome (ACS) undergoing coronary revascularization. We aimed to determine whether a reduction in hemoglobin (Hgb) from pre- to postpercutaneous coronary intervention (PCI), with or without evidence of clinical bleeding, is a correlate of in-hospital mortality for patients presenting with ACS who underwent primary PCI. METHODS: We divided 33816 consecutive patients with ACS who underwent PCI into three categories: (1) target group (defined as Hgb reduction without overt bleeding [n = 112]); (2) Hgb reduction with overt bleeding (n = 48); and (3) control group (defined as no Hgb reduction and no overt bleeding [n = 3156]). Hgb reduction was defined as a drop of >3 g/dL in Hgb value from preprocedure and postprocedure during the index hospitalization. The primary outcome was in-hospital mortality. We used logistic regression to examine the relationship between Hgb reduction with and without bleeding and in-hospital mortality. RESULTS: In crude analysis, the Hgb reduction with overt bleed group had a higher in-hospital mortality rate (16.7%) than the target (9.8%) and control groups (0.6%). Adjusted logistic regression estimates a 0.393 (95% confidence interval [CI]: 0.137, 1.869) odds ratio for in-hospital death of the target group over the Hgb reduction with bleed group, and a 54.517 (95% CI: 2.07, >1000) odds ratio of the target group over the control group. CONCLUSIONS: In patients presenting with ACS undergoing PCI, Hgb reduction with and without overt bleeding were both independently associated with in-hospital mortality.
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Aladin et al. (2023) studied this question.
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