Periprocedural hemoglobin changes and myocardial injury in patients undergoing percutaneous coronary intervention

Background: Patients undergoing percutaneous coronary intervention are at serious risk of different complications such as periprocedural bleeding that can lead to myocardial injuries. Blood loss through puncture site hematoma formation and through catheter aspiration causes periprocedural hemoglobin drop.

Objectives: Although percutaneous coronary intervention is an effective treatment of coronary artery disease, it seems necessary to investigate the impact of complications on outcomes including myocardial infarction and possible mortality. The purpose of this study was to evaluate the relationship between periprocedural hemoglobin levels and cardiac enzyme changes as a predictor of cardiac adverse outcomes in patients undergoing percutaneous coronary intervention.

Patients and methods: This study was conducted on 1012 consecutive patients with a diagnosis of coronary artery disease who underwent percutaneous coronary intervention. Hemoglobin levels were measured immediately before and post-procedurally and based on the baseline levels the patients were classified into anemic and non-anemic groups. The samples for TnI and CP-MB were collected before the procedure and at 8, 16, and 24 hours post-procedurally. The patients were stratified into three categories of myocardial injuries: patients with CK-MB ≥ 3×; those with TnI > 0.06 µu/l and individuals with both CK-MB ≥ 3× and TnI > 0.06 µu/l.

Results: All categories divided by cardiac enzyme status either in positive or in negative groups were classified in non-anemic group. Although in all groups hemoglobin level decreased post-procedurally, in the second category (TnI ≥ 0.06) the positive patients had significantly lower hemoglobin amounts after the procedure (P = 0.008).

Conclusion: Post-procedure hemoglobin dropping may be considered as a predictor of cardiac adverse outcome in patients undergoing PCI. We suggest that a good bleeding control during and after the procedure can reduce the risk of cardiac enzyme elevation post-procedurally.