Transfusion and mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
Abstract
AIMS: Red blood cell transfusion is associated with increased mortality among patients with acute coronary syndromes, but little is known about the consequences of transfusion in a contemporary setting of ST-segment elevation myocardial infarction. We describe the association between transfusion and 90-day mortality among patients with acute myocardial infarction treated with primary percutaneous coronary intervention. METHODS AND RESULTS: Analyses were performed on 5532 patients with ST-elevation myocardial infarction from the Assessment of Pexelizumab in Acute Myocardial Infarction trial. The primary objective of this analysis was to ascertain the relation between red blood cell transfusion and 90-day mortality in patients with recent myocardial infarction. We initially determined the baseline and in-hospital predictors of transfusion (multivariable logistic regressions) and subsequently assessed the association between transfusion and mortality using a series of Cox proportional hazards regression combined to a landmark analyses. A total of 213 patients (3.9%) received a transfusion. Transfusion remained significantly associated with mortality [hazards ratio = 2.16 (1.20-3.88)], despite adjustment for baseline characteristics, in-hospital co-interventions, and for propensity of receiving a transfusion. Among patients who survived to hospital discharge, however, the hazard of death was not different in patients treated with transfusion. CONCLUSION: Transfusion is associated with 90-day mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. Although transfusion may be causally related to mortality, it is likely that at least part of the association is due to confounding. This association illustrates the complex relationship between transfusion, bleeding, and mortality and underscores the need for further research to understand the relationship between transfusion and clinical outcomes.
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Therapeutic interventions aimed to increase the circulating number of RBCs (transfusion of blood or administration of erythropoiesis-stimulating agents) were not always effective in the tested cohorts.
“However, therapeutic interventions aimed to increase the circulating number of RBCs (e.g., by transfusion of blood or by administration of erythropoiesis-stimulating agents [ESAs] to stimulate the production of RBCs by the bone marrow), were not always effective in the tested cohorts (48, 91, 156).”
From Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia (2017) · cites this paper as [91]
Big cohort/epidemiological studies show associations between anemia and cardiovascular complications.
“Interestingly, there are big cohort/epidemiological studies showing associations between anemia and cardiovascular complications (48, 87, 91).”
From Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia (2017) · cites this paper as [91]
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Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia
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Anemia in Critical Illness: Insights into Etiology, Consequences, and Management
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- Authors
- Jolicœur, E. M., O'Neill, W. W., Hellkamp, A., Hamm, C. W., Holmes, D. R., Al-Khalidi, H. R., Patel, M. R., Van de Werf, F. J., Pieper, K., Armstrong, P. W., & Granger, C. B.
- Affiliations
- Duke Clinical Research Institute (US)
- Kerckhoff Klinik (DE)
- Mayo Clinic (US)
- University of Alberta (CA)
- Corresponding author
- Granger, Christopher B.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-07-11
- Volume
- 30
- Issue
- 21
- Pages
- 2575-2583
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2004374080
- Cited by
- 54
- References
- 41
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 3 · 2021: 1 · 2019: 1 · 2018: 3 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 5 · 2013: 8 · 2012: 6
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- red blood cell transfusion, ST-elevation myocardial infarction, primary percutaneous coronary intervention, 90-day mortality, transfusion-related mortality, hemorrhage, confounding, acute myocardial infarction, pexelizumab
- MeSH terms
- Aged, Female, Hemorrhage, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction, Angioplasty, Balloon, Coronary, Multivariate Analysis, Erythrocyte Transfusion, Kaplan-Meier Estimate
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