{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:45:18Z","timestamp":1789051518602,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although baseline hemoglobin and renal function are both important predictors of adverse outcomes after percutaneous coronary intervention (PCI), scarce data exist regarding the combined impact of these factors on outcomes. We sought to investigate the impact and threshold value of the hemoglobin to creatinine (Hgb\/Cr) ratio, on in-hospital adverse outcomes among non-dialysis patients in a Japanese nationwide registry. We analyzed 157,978 non-dialysis patients who underwent PCI in 884 Japanese medical institutions in 2017. We studied differences in baseline characteristics and in-hospital clinical outcomes among four groups according to their quartiles of the Hgb\/Cr ratios. Compared with patients with higher Hgb\/Cr ratios, patients with lower ratios were older and had more comorbidities and complex coronary artery disease. Patients with lower hemoglobin and higher creatinine levels had a higher rate of in-hospital adverse outcomes including in-hospital mortality and procedural complications (defined as occurrence of cardiac tamponade, cardiogenic shock after PCI, emergency operation, or bleeding complications that required blood transfusion). On multivariate analyses, Hgb\/Cr ratio was inversely associated with in-hospital mortality (odds ratio: 0.91, 95% confidence interval: 0.89\u20130.92; p &lt; 0.001) and bleeding complications (odds ratio: 0.92, 95% confidence interval: 0.90\u20130.94; p &lt; 0.001). Spline curve analysis demonstrated that these risks started to increase when the Hgb\/Cr ratio was &lt;15, and elevated exponentially when the ratio was &lt;10. Hgb\/Cr ratio is a simple index among non-dialysis patients and is inversely associated with in-hospital mortality and bleeding complications after PCI.<\/jats:p>","DOI":"10.3390\/jcm9113612","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T14:10:41Z","timestamp":1605017441000},"page":"3612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1739-2800","authenticated-orcid":false,"given":"Yohei","family":"Numasawa","sequence":"first","affiliation":[{"name":"Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi 326-0843, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taku","family":"Inohara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4348-0123","authenticated-orcid":false,"given":"Hideki","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya 454-8509, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8798-9186","authenticated-orcid":false,"given":"Kyohei","family":"Yamaji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":false,"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2789-1758","authenticated-orcid":false,"given":"Mitsuaki","family":"Sawano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Kodaira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi 326-0843, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Uemura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kawasaki Medical School, Kurashiki 701-0192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushige","family":"Kadota","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kurashiki Central Hospital, Kurashiki 710-8602, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Amano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-4324","authenticated-orcid":false,"given":"Yuji","family":"Ikari","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Tokai University School of Medicine, Isehara 259-1193, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e007133","DOI":"10.1161\/CIRCINTERVENTIONS.118.007133","article-title":"Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous Coronary Intervention","volume":"12","author":"Faggioni","year":"2019","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e013703","DOI":"10.1161\/JAHA.119.013703","article-title":"CREDO-Kyoto PCI\/CABG Registry Cohort-2, RESET and NEXT Investigators. Prognostic Impact of Baseline Hemoglobin Levels on Long-Term Thrombotic and Bleeding Events after Percutaneous Coronary Interventions","volume":"8","author":"Nagao","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.amjcard.2017.12.007","article-title":"Relation of Baseline Hemoglobin Level to In-Hospital Outcomes in Patients Who Undergo Percutaneous Coronary Intervention (from a Japanese Multicenter Registry)","volume":"121","author":"Numasawa","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1161\/CIRCINTERVENTIONS.111.965749","article-title":"The impact of anemia on long-term clinical outcome in patients undergoing revascularization with the unrestricted use of drug-eluting stents","volume":"5","author":"Pilgrim","year":"2012","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.amjcard.2016.05.059","article-title":"Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention","volume":"118","author":"Kwok","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.amjcard.2017.02.052","article-title":"Relation of Baseline Hemoglobin Levels and Adverse Events in Patients With Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage strategY and Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction Trials)","volume":"119","author":"Brener","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/eurheartj\/ehp401","article-title":"Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes","volume":"31","author":"Bassand","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/j.jacc.2003.06.001","article-title":"Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality","volume":"42","author":"Gibson","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1136\/heart.89.9.1003","article-title":"Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: Findings from the global registry of acute coronary events (GRACE)","volume":"89","author":"Santopinto","year":"2003","journal-title":"Heart"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1016\/j.jcin.2016.06.051","article-title":"Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry","volume":"9","author":"Lee","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/j.jacc.2011.06.056","article-title":"Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease: A report from the linked CathPCI Registry-CMS claims database","volume":"58","author":"Tsai","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1161\/CIRCULATIONAHA.109.865352","article-title":"Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: A report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry","volume":"121","author":"Fox","year":"2010","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1002\/ccd.23394","article-title":"Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing percutaneous coronary intervention","volume":"80","author":"Parikh","year":"2012","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1002\/ccd.27986","article-title":"An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry","volume":"94","author":"Numasawa","year":"2019","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jcin.2013.03.020","article-title":"Enhanced mortality risk prediction with a focus on high-risk percutaneous coronary intervention: Results from 1,208,137 procedures in the NCDR (National Cardiovascular Data Registry)","volume":"6","author":"Brennan","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.jcin.2013.04.016","article-title":"An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: A report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry","volume":"6","author":"Rao","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s00380-011-0209-2","article-title":"Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients","volume":"28","author":"Matsue","year":"2013","journal-title":"Heart Vessels"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1536\/ihj.13-367","article-title":"Prognostic impact of chronic kidney disease and anemia at admission on in-hospital outcomes after primary percutaneous coronary intervention for acute myocardial infarction","volume":"55","author":"Shiraishi","year":"2014","journal-title":"Int. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pilgrim, T., Rothenbuhler, M., Kalesan, B., Pulver, C., Stefanini, G.G., Zanchin, T., Raber, L., Stortecky, S., Jung, S., and Mattle, H. (2014). Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114846"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5221","DOI":"10.1016\/j.ijcard.2013.08.029","article-title":"Prognostic implications of anemia with or without chronic kidney disease in patients undergoing elective percutaneous coronary intervention","volume":"168","author":"Kitai","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.ahj.2008.10.021","article-title":"Baseline hemoglobin concentration and creatinine clearance composite laboratory index improves risk stratification in ST-elevation myocardial infarction","volume":"157","author":"Giraldez","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e011183","DOI":"10.1161\/JAHA.118.011017","article-title":"Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry)","volume":"8","author":"Numasawa","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s12928-018-0516-y","article-title":"CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018","volume":"33","author":"Ozaki","year":"2018","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s12928-019-00582-0","article-title":"Post-interventional adverse event risk by vascular access site among patients with acute coronary syndrome in Japan: Observational analysis with a national registry J-PCI database","volume":"34","author":"Fujii","year":"2019","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s12928-020-00669-z","article-title":"Contemporary use and trends in percutaneous coronary intervention in Japan: An outline of the J-PCI registry","volume":"35","author":"Sawano","year":"2020","journal-title":"Cardiovasc. Interv. Ther"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.amjcard.2016.11.034","article-title":"Comparison of Outcomes of Women Versus Men With Non-ST-elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention (from the Japanese Nationwide Registry)","volume":"119","author":"Numasawa","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kohsaka, S., Kumamaru, H., Inohara, T., Amano, T., Akasaka, T., Miyata, H., Motomura, N., and Nakamura, M. (2020). Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051267"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1159\/000180580","article-title":"Prediction of creatinine clearance from serum creatinine","volume":"16","author":"Cockcroft","year":"1976","journal-title":"Nephron"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kuno, T., Numasawa, Y., Mikami, T., Niimi, N., Sawano, M., Kodaira, M., Suzuki, M., Ueno, K., Ueda, I., and Fukuda, K. (2020). Association of decreasing hemoglobin levels with the incidence of acute kidney injury after percutaneous coronary intervention: A prospective multi-center study. Heart Vessels.","DOI":"10.1007\/s00380-020-01706-w"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.jacc.2013.03.086","article-title":"Impact of periprocedural bleeding on incidence of contrast-induced acute kidney injury in patients treated with percutaneous coronary intervention","volume":"62","author":"Ohno","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized Bleeding Definitions for Cardiovascular Clinical Trials: A Consensus Report From the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:31:27Z","timestamp":1760178687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,10]]},"references-count":31,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["jcm9113612"],"URL":"https:\/\/doi.org\/10.3390\/jcm9113612","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,10]]}}}