Impact of Blood Transfusion on Short- and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction

Objectives We sought to examine the short- and long-term outcomes of blood transfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI). Background The short- and long-term consequences of blood transfusion in anemic patients with recent STEMI remain controversial. Methods We evaluated 30-day, 6-month, and 1-year all-cause mortality among 4,131 STEMI patients enrolled in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial. Patients were categorized according to whether they received a blood transfusion during hospitalization. Cox proportional hazards survival models with transfusion as a time-dependent covariate were conducted for the whole and for the propensity-matched groups. Additionally, a series of sensitivity analyses assessed the magnitude of hidden bias that would need to be present to explain the associations actually observed. Results Death at 30 days (13.7% vs. 5.5%), 6 months (19.7% vs. 6.9%), and 1 year (21.8% vs. 8.7%) was significantly higher for transfused patients than for nontransfused patients, respectively. After adjusting for over 25 baseline characteristics, nadir hemoglobin, and propensity score for transfusion, and using transfusion as a time-dependent covariate, transfusion remained significantly associated with increased risk of mortality at 30 days (hazard ratio [HR]: 3.89, 95% confidence interval [Cl]: 2.66 to 5.68, p < 0.001), 6 months (HR: 3.63, 95% Cl: 2.67 to 4.95, p < 0.001), and 1 year (HR: 3.03, 95% Cl: 2.25 to 4.08, p < 0.001). Similar results were observed in the propensity-matched patients. Conclusions Blood transfusion is associated with increased short- and long-term mortality in the setting of STEMI. (J Am Coll Cardiol Intv 2009;2:46-53) (C) 2009 by the American College of Cardiology Foundation