title: Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.affiliation: Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Rothenbühler
authors.affiliation: Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Pulver
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Giulio G
authors.initials: GG
authors.lastname: Stefanini
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zanchin
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Department of Neurology, Bern University Hospital, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Bern University Hospital, Bern, Switzerland.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Mattle
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D006454:Hemoglobins