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Transfusion in PCI associated with adverse events
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Patients who underwent PCI and received red blood cell transfusions experienced higher rates of stroke and MI than those who did not receive transfusions, according to findings published in JAMA.
Investigators conducted a retrospective cohort study using data culled from the CathPCI registry from July 2009 to March 2013 to determine current trends in blood transfusion among patients undergoing PCI for ACS. They suggested that there is variation in how red blood cell transfusion is used in this patient population, and how this practice impacts outcomes.
The analysis included 2,258,711 visits.
The primary outcome measure was transfusion rates in the overall population by hospital, which included 1,431 transfusions. Investigators assessed associations between transfusion and outcomes, including death, MI and stroke.
Transfusions occurred in 2.14% of the cohort (95% CI, 2.13-2.16). In July 2009, the quarterly transfusion rate was 2.11% (95% CI, 2.03-2.19) compared with 2.04% by March 2013 (95% CI, 1.97-2.12; P<.001).
Older patients (mean age, 70.5 years) were more likely to receive a transfusion compared with younger patients (mean age, 64.6 years). Transfusion rates were higher in several patient subcohorts, including:
- Women (56.3%) vs. men (32.5%);
- Hypertension (86.4%) vs. no hypertension (82%);
- Diabetes (44.8%) vs. no diabetes (34.6%);
- Advanced renal dysfunction (8.7%) vs. no advanced renal dysfunction (2.3%);
- Previous MI (33%) vs. no previous MI (30.2%);
- Previous HF (27%) vs. no previous HF (11.8%).
Of the sites evaluated, 96.3% administered transfusions to fewer than 5% of eligible patients. Transfusion rates of 5% or higher occurred at 3.7% of the sites.
Adjusted analysis results indicated that risk-standardized rates of transfusion between hospitals persisted. Variability also was reported in hospital risk thresholds.
In patients undergoing PCI, those who received transfusion of red blood cells had an MI rate of 4.5% (42,803 events) while those who did not had an MI rate of 1.8% (OR=2.6; 95% CI, 2.57-2.63). Transfusion was associated with a 2% rate of stroke (5,011 events) compared with a 0.2% stroke rate among those not receiving transfusions (OR=7.72; 95% CI, 7.47-7.98). In-hospital mortality rates were 12.5% in the transfusion group (31,885 events) and 1.2% in the non-transfusion group (OR=4.63; 95% CI, 4.57-4.69). These events occurred regardless of bleeding complications, according to the investigators.
“Among patients undergoing PCI at US hospitals, there was considerable variation in blood transfusion practices, and receipt of transfusion was associated with increased risk of in-hospital adverse cardiac events,” they concluded. “These observational findings may warrant a randomized trial of transfusion strategies for patients undergoing PCI.”
Disclosure: The researchers report financial disclosures with Boehringer Ingelheim, Eli Lilly, Genentech, Janssen, Medtronic, Merck, Sanofi Aventis and the Society of Thoracic Surgeons.
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