Impact of persistent anaemia on mortality in patients hospitalised with acute pulmonary embolism: an Australian retrospective observational study.

OBJECTIVES: Anaemia is associated with increased mortality in acute pulmonary embolism (PE) patients. However, prior studies have not examined the prognostic impact of trends in plasma haemoglobin during admission. This study investigates the impact of changes in haemoglobin level on mortality during hospital stay in acute PE. STUDY DESIGN: A retrospective observational study. SETTING: Tertiary-referral centre in Australia. PARTICIPANTS: Consecutive patients from 2000 to 2012 admitted with confirmed acute PE were identified from a dedicated PE database. Haemoglobin levels on days 1, 3-4, 5-6 and 7 of admission were retrieved. Patients without both baseline haemoglobin and subsequent haemoglobin levels were excluded (n=327), leaving 1099 patients as the study cohort. Anaemia was defined as haemoglobin <130 g/L for men and <120 g/L for women. There were 576 patients without anaemia throughout admission, 65 with transient anaemia (anaemic on day 1, but subsequently normalised during admission), 122 with acquired anaemia (normal on day 1 but developed anaemia during admission) and 336 with persistent anaemia. A total of 71 patients received blood transfusion during admission. MAIN OUTCOME MEASURE: 6-month mortality was tracked from a state-wide death database and analysed using multivariable modelling. RESULTS: After adjusting for transfusion, patietns with persistent anaemia had a significantly increased 6-month mortality risk (adjusted HR 1.97, 95% CI 1.26 to 3.09, p=0.003) compared with patients without anaemia. There was no difference in mortality between patients with transient or acquired anaemia and patients without anaemia. CONCLUSION: Among patients who had anaemia during their admission for acute PE, only the subgroup with persistent anaemia demonstrated worse outcomes.

A Comparison of Image Quality Using Radial vs Femoral Approaches in Patients Undergoing Diagnostic Coronary Angiography.

INTRODUCTION: Radial access for diagnostic coronary angiography (CAG) has gained traction in recent years over the femoral artery approach, but difference in image quality has not been extensively studied. This study aims to compare image quality and diagnostic value in radial vs femoral access in patients undergoing invasive CAG. METHODS: This is a retrospective study of 200 patients (100 radial and 100 femoral) undergoing CAG at an experienced center from 2014 to 2015. The primary endpoint was angiographic image quality, and secondary endpoints were proportion of non-diagnostic images and patient radiation dose. Image quality was assessed by four experienced angiographers using a quantitative scale. Mean differences in scores were compared as well as proportion of non-diagnostic images produced. RESULTS: Radial access produced images that were significantly poorer than femoral access when viewing the left coronary artery (2.65 ± 0.04 vs 2.79 ± 0.03; P<.01). This difference remained significant after adjusting for age, gender, and catheter size (P=.04). There was no significant difference in image quality between the radial and femoral group when viewing the right coronary artery (2.91 ± 0.03 vs 2.84 ± 0.04; P=.11). There was a higher proportion of non-diagnostic images produced by radial access than femoral (3.23% vs 2.02%; P<.01) and radial access resulted in higher patient radiation doses (832.81 ± 49.59 mGy vs 645.69 ± 35.46 mGy; P<.01). CONCLUSION: Radial access produces poorer angiographic image quality and exposes patients to greater radiation compared to femoral access in contemporary practice. An awareness of these limitations is important when selecting mode of access in patients undergoing diagnostic CAG.

Red blood cell transfusion and outcomes in acute pulmonary embolism.

BACKGROUND AND OBJECTIVE: Blood transfusion has been associated with adverse outcomes in certain conditions. This study investigates the prevalence and outcomes of red blood cell (RBC) transfusion in patients with acute pulmonary embolism (PE). METHODS: Retrospective study of consecutive patients from 2000 to 2012 admitted to a tertiary hospital with a primary diagnosis of acute PE. Transfusion status during the hospital admission was ascertained. Mortality was tracked from a state-wide death database and analysed using multivariable modelling. RESULTS: A total of 73 patients (5% of all patients admitted with PE) received RBC transfusion during their admission. These patients were significantly older, had more co-morbidities, worse haemodynamics, higher simplified pulmonary embolism severity index scores, and lower plasma sodium and haemoglobin (Hb) levels at admission. Unadjusted mortality for the transfused group was significantly higher at 30-day (19% vs 4%, P < 0.001) and 6-month (40% vs 10%, P < 0.001) follow-up. Multivariable modelling showed RBC transfusion to be a significant independent predictor of mortality at 30-day (odds ratio 3.06, 95% CI: 1.17-8.01, P = 0.02) and 6-month (hazard ratio (HR) 1.97, 95% CI: 1.12-3.46, P = 0.02). Sensitivity analysis confirmed that transfused patients had higher mortality than non-transfused patients in the subgroup of patients with Hb <100 g/L. CONCLUSION: RBC transfusion in patients hospitalized with acute PE is rare and appears to be associated with increased risk of short- and long-term mortality, independent of Hb level on admission. This finding underscores the need for future randomized controlled studies on the impact of RBC transfusion in the management of patients admitted with acute PE. [Correction added on 4 May 2018, after first online publication: the word 'serum' was changed to 'plasma' throughout the article where appropriate.].