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Blood transfusions linked with mortality in patients with STEMI
A post hoc analysis of data from the GUSTO IIb trial suggested links, despite age of trial data.
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Results of an outcomes analysis suggested that blood transfusion is associated with both short- and long-term mortality in the setting of ST-segment elevation MI.
Researchers evaluated data from a cohort of 3,575 patients with transient or persistent ST-segment elevation of more than 0.5 mm who were enrolled in the GUSTO IIb trial. Of the 3,575 patients included in the study cohort, 307 (8.6%) received a blood transfusion while hospitalized, of which 297 (96.7%) had moderate to severe bleeding.
According to the study results, patients receiving blood transfusions had higher mortality rates at 30 days (13.7% vs. 5.5%, P<.01), six months (19.7% vs. 6.9%, P<.01) and one year (21.8% vs. 8.7%, P<.01) compared with patients who had not received a transfusion. Researchers also reported that in a multivariable and propensity-score adjusted analysis, blood transfusion was associated with all-cause mortality for 30 days, six months and one year (P<.001 for all values). They also reported that transfusion was associated with incident MI at 30 days (P<.001) and at six months (P<.001).
The researchers acknowledged that the study was limited by the fact that it was a post hoc analysis and that the pharmacological and interventional therapies performed on the cohort had changed since the GUSTO IIb trial was conducted between 1994 and 1995.
“GUSTO IIb included a broad representation of population with a wide spectrum of coexisting conditions, but it may still not reflect the real world population,” the researchers wrote in their conclusion. “However, bleeding remains an important complication associated with pharmacologic therapy in patients presenting with acute coronary syndromes and its treatment with stored blood product has not changed since the GUSTO IIb era.”
For more information:
- J Am Coll Cardiol Intv. 2009;2:46-53.
This is an important, well designed study highlighting possible risk associated with blood transfusion in patients with STEMI. There has been growing concern about adverse effects of storage on red blood cells that may lead, among other things, to ‘plugging’ of erythrocytes in the microvasculature after transfusion. Such defects in erythrocyte function would pose an obvious threat to patients with vascular disease, and may be especially worrisome in the setting of acute MI when microvascular function is already compromised. Although this retrospective study cannot prove a cause-and-effect relationship between blood transfusion and adverse outcomes (patients requiring blood are clearly at increased risk already), the authors robust statistical analysis does raise genuine concern that blood transfusion may be harmful for some patients. Their conclusion that a randomized controlled trial is needed to clarify the role of blood transfusion in patients with STEMI is justified. Whilst that data is awaited, use of blood transfusion for soft indications following STEMI - in the belief that a transfusion ‘can do no harm’ – should certainly be restricted.
Brendan Doyle, MB, BCh
Cardiology Today Fellows Advisory Board member