Wu W C, Rathore S S, Wang Y, Radford M J, Krumholz H M
Division of Cardiovascular Diseases, Brown University Medical School, Providence, RI, USA.
N Engl J Med. 2001 Oct 25;345(17):1230-6. doi: 10.1056/NEJMoa010615.
Anemia may have adverse effects in patients with coronary artery disease. However, the benefit of blood transfusion in elderly patients with acute myocardial infarction and various degrees of anemia is uncertain.
We conducted a retrospective study of data on 78,974 Medicare beneficiaries 65 years old or older who were hospitalized with acute myocardial infarction. Patients were categorized according to the hematocrit on admission (5.0 to 24.0 percent, 24.1 to 27.0 percent, 27.1 to 30.0 percent, 30.1 to 33.0 percent, 33.1 to 36.0 percent, 36.1 to 39.0 percent, or 39.1 to 48.0 percent), and data were evaluated to determine whether there was an association between the use of transfusion and 30-day mortality.
Patients with lower hematocrit values on admission had higher 30-day mortality rates. Blood transfusion was associated with a reduction in 30-day mortality among patients whose hematocrit on admission fell into the categories ranging from 5.0 to 24.0 percent (adjusted odds ratio, 0.22; 95 percent confidence interval, 0.11 to 0.45) to 30.1 to 33.0 percent (adjusted odds ratio, 0.69; 95 percent confidence interval, 0.53 to 0.89). It was not associated with a reduction in 30-day mortality among those whose hematocrit values fell in the higher ranges. In one of seven subgroup analyses (among patients who survived at least two days), transfusion was not associated with a reduction in mortality for patients with hematocrit values of 30.1 percent or higher.
Blood transfusion is associated with a lower short-term mortality rate among elderly patients with acute myocardial infarction if the hematocrit on admission is 30.0 percent or lower and may be effective in patients with a hematocrit as high as 33.0 percent on admission.
贫血可能对冠状动脉疾病患者产生不良影响。然而，输血对于老年急性心肌梗死合并不同程度贫血患者的益处尚不确定。
我们对78974例65岁及以上因急性心肌梗死住院的医疗保险受益人的数据进行了回顾性研究。根据入院时的血细胞比容将患者分类（5.0%至24.0%、24.1%至27.0%、27.1%至30.0%、30.1%至33.0%、33.1%至36.0%、36.1%至39.0%或39.1%至48.0%），并对数据进行评估，以确定输血与30天死亡率之间是否存在关联。
入院时血细胞比容值较低的患者30天死亡率较高。输血与入院时血细胞比容在5.0%至24.0%（校正比值比，0.22；95%置信区间，0.11至0.45）至30.1%至33.0%（校正比值比，0.69；95%置信区间，0.53至0.89）范围内的患者30天死亡率降低相关。在血细胞比容值处于较高范围的患者中，输血与30天死亡率降低无关。在七项亚组分析中的一项（至少存活两天的患者）中，对于血细胞比容值为30.1%或更高的患者，输血与死亡率降低无关。
对于入院时血细胞比容为30.0%或更低的老年急性心肌梗死患者，输血与较低的短期死亡率相关，对于入院时血细胞比容高达33.0%的患者可能也有效。
