Prognostic Implications of Hemoglobin Drop With and Without Overt Bleeding After Percutaneous Coronary Intervention (JACC Asia December 2025)-Article: Prognostic Implications of Hemoglobin Drop With and Without Overt Bleeding After Percutaneous Coronary Intervention

Article: Prognostic Implications of Hemoglobin Drop With and Without Overt Bleeding After Percutaneous Coronary Intervention

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This JACC Asia original research examined whether a periprocedural hemoglobin (Hb) drop of ≥3.0 g/dL after percutaneous coronary intervention (PCI)—a laboratory-based criterion included in some bleeding definitions—has prognostic significance, particularly when no clinically overt bleeding is observed.<br /><br />Using the contemporary, prospective multicenter Japanese JCD-KiCS registry (15 hospitals; 2008–2021), the investigators analyzed 7,145 patients who underwent PCI and were discharged alive (mean age 69 years; 77% men). Hb drop was defined as the difference between the lowest Hb within 72 hours before PCI and the lowest Hb within 72 hours after PCI. Overt bleeding within 72 hours (or before discharge) included access-site bleeding/hematoma beyond size thresholds, retroperitoneal/gastrointestinal/genitourinary bleeding, intracranial hemorrhage, tamponade, or bleeding requiring transfusion. Patients were categorized into four groups: both overt bleeding and Hb drop (1.0%), overt bleeding only (1.2%), Hb drop only (8.3%), and no bleeding (89.5%; reference).<br /><br />Over a median 2-year follow-up, 12.2% experienced major adverse cardiac events (MACE: all-cause death, acute coronary syndrome, heart failure hospitalization, or stroke). MACE incidence was highest in patients with both overt bleeding and Hb drop (30.1%). After multivariable adjustment, this group had significantly higher 2-year MACE risk versus no bleeding (adjusted HR 2.16) and higher mortality risk (adjusted HR 2.64). In contrast, Hb drop without overt bleeding was not associated with increased MACE (adjusted HR 1.20) and showed limited prognostic value at the 3.0 g/dL threshold.<br /><br />The study concludes that Hb decline is clinically meaningful primarily when accompanied by overt bleeding, underscoring the need to interpret post-PCI Hb drops within clinical context rather than as standalone “bleeding” events.

Keywords

JACC Asia

percutaneous coronary intervention

PCI bleeding definitions

hemoglobin drop 3.0 g/dL

periprocedural anemia

overt bleeding

JCD-KiCS registry

major adverse cardiac events

prognostic significance

Japanese multicenter cohort