Impact of red blood cell transfusion on clinical outcomes in patients with acute myocardial infarction

被引:82
作者
Aronson, Doron [1 ]
Dann, Eldad J. [2 ,3 ,4 ]
Bonstein, Lilach [3 ,4 ]
Blich, Miry [1 ]
Kapeliovich, Michael [1 ]
Beyar, Rafael [1 ]
Markiewicz, Walter [1 ]
Hammerman, Haim [1 ]
机构
[1] Technion Israel Inst Technol, Bruce Rappaport Fac Med, Dept Cardiol, IL-31096 Haifa, Israel
[2] Technion Israel Inst Technol, Bruce Rappaport Fac Med, Dept Hematol, IL-31096 Haifa, Israel
[3] Technion Israel Inst Technol, Bruce Rappaport Fac Med, Dept Blood Bank, IL-31096 Haifa, Israel
[4] Technion Israel Inst Technol, Rambam Med Ctr, Apheresis Unit, Haifa, Israel
关键词
D O I
10.1016/j.amjcard.2008.03.027
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Divergent views remain regarding the safety of treating anemia with red blood cell (RBC) transfusion in patients with acute coronary syndrome (ACS). We used a prospective database to study effect of RBC transfusion in patients with acute myocardial infarction (MI; n = 2,358). Cox regression models were used to determine the association between RBC transfusion and 6-month outcomes, incorporating transfusion as a time-dependent variable. The models adjusted for baseline variables, propensity for transfusion, and nadir hemoglobin previous to the transfusion. One hundred ninety-two patients (8.1%) received RBC transfusion. Six-month mortality rates were higher in patients receiving transfusion (28.1% vs 11.7%, p < 0.0001). The adjusted hazard ratio (HR) for mortality was 1.9 in transfused patients (95% confidence interval [CI] 1.3 to 2.9). Interaction between RBC transfusion and nadir hemoglobin with respect to mortality (p = 0.004) was significant. Stratified analyses showed a protective effect of transfusion in patients with nadir hemoglobin:58 g/dL (adjusted HR 0.13, 95% Cl 0.03 to 0.65, p = 0.013). By contrast, transfusion was associated with increased mortality in patients with nadir hemoglobin > 8 g/dL (adjusted HR 2.2, 95% CI 1.5 to 3.3; p < 0.0001). Similar results were obtained for the composite end point of death/MI/heart failure (p for interaction = 0.04). In conclusion, RBC transfusion in patients with acute MI and hemoglobin <= 8 g/dL may be appropriate. The increased mortality observed in transfused patients with nadir hemoglobin above 8 g/dL underscores the clinical difficulty of balancing risks and benefits of RBC transfusion in the setting of ACS. (C) 2008 Elsevier Inc. All rights reserved.
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收藏
页码:115 / 119
页数:5
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