Clinical Outcomes in Anemic Women Undergoing Elective Percutaneous Coronary Intervention: A Retrospective Cohort Analysis.

purposeAnemia is common among women undergoing elective percutaneous coronary intervention (PCI), yet remains under-addressed in contemporary ACC/AHA guidelines. We evaluated the association between baseline anemia and short- and long-term outcomes after PCI.

methodsUsing the TriNetX federated electronic health record network, we identified women undergoing first-time elective PCI and compared anemic vs. non-anemic patients. One-to-one propensity score matching yielded N = 1,153 per group, balancing demographics, comorbidities, medications, and labs. Clinical outcomes were assessed at 7 days, 30 days, 6 months, and 12 months, and included major adverse cardiovascular events (MACE), acute coronary syndrome (ACS), acute kidney injury (AKI), stroke or transient ischemic attack (TIA), major bleeding, transfusion requirements, all-cause hospitalization, in-stent restenosis, stent thrombosis, and all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards models.

resultsAt 7 days post-procedure, baseline anemia was significantly associated with an increased risk of AKI (HR 2.2; 95% confidence interval [CI], 1.1-4.5; p = 0.03), major bleeding events (HR 3.2; 95% CI, 1.4-7.5; p < 0.01), and transfusion requirements (HR 9.1; 95% CI, 2.1-39.2; p < 0.01). Notably, all 7-day mortality events occurred in the anemic cohort (0.9% vs. 0.0%). By 30 days, patients with anemia continued to demonstrate higher rates of AKI, major bleeding, and transfusion needs. At 12 months, these risks persisted and, in some cases, widened. Anemia was independently associated with increased rates of major adverse cardiovascular events (MACE) (HR 1.4; 95% CI, 1.1-1.8; p = 0.01), AKI (HR 1.9; 95% CI, 1.5-2.5; p < 0.01), all-cause hospitalization (HR 1.3; 95% CI, 1.1-1.5; p < 0.01), and all-cause mortality (HR 2.3; 95% CI, 1.4-3.8; p < 0.01). Differences in stroke or TIA rates were not statistically significant, and the incidence of stent thrombosis or restenosis was comparable between anemic and non-anemic groups.

conclusionsAmong women undergoing elective PCI, baseline anemia emerged as a strong predictor of adverse outcomes, spanning early kidney/bleeding complications and sustained increases in MACE, hospitalizations, and mortality over one year, without clear differences in stent-related events. These data support integrating anemia into pre-PCI risk assessment and motivate randomized trials of pre-procedural anemia optimization.