Introduction:
The safety of red blood cells transfusion (RBC-T) in patients (pts) with acute coronary syndromes is controversial, with some studies suggesting that RBC-T may adversely affect outcome.
Methods:
We studied the relationship between RBC-T during hospitalization and 6-months mortality in 2325 pts with acute myocardial infarction (AMI).Propensity score for RBC-T was calculated based on a logistic regression model incorporating age, sex, baseline hemoglobin (Hb), creatinine, diabetes, smoking, blood pressure and heart rate, Killip class, thrombolytic therapy and coronary interventions. The association between RBC-T and mortality was assessed using Cox mode with RBC-T as a time-dependent covariate, adjusting for the propensity to receive RBC-T and nadir Hb prior to RBC-T.
Results:
One hundred and ninety one pts (8.2%) received RBC-T. Median nadir Hb was markedly lower in pts receiving RBC-T (8.8 gr/dL [interquartile range 8.2–9.3]) compared with pts not receiving RBC-T (12.8 gr/dL [interquartile range 11.6 –13.9];
P
< 0.0001). Mortality increased progressively in pts receiving RBC-T over the 6-months follow-up (Figure
). The unadjusted hazard ratio (HR) for mortality in pts receiving RBC-T was 4.1 (95% CI 3.0 –5.7,
P
< 0.0001). The effect of RBC-T was attenuated but remained significant after adjustments for the propensity to receive RBC-T (HR 2.1; 95% CI 1.4 –3.2,
P
< 0.0001). However, after adjusting for nadir Hb, the association between RBC-T and mortality was not significant (HR 1.4; 95% 0.9 –2.1,
P
= 0.09).
Conclusion:
The transfusion-associated risk in patients with AMI reflects the severity of the anemia at the time of transfusion and associated comorbidities.
Risk Factors for Rehospitalization for Acute Coronary Syndromes and Unplanned Revascularization Following Acute Myocardial Infarction