Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
JACC Cardiovasc Interv. 2009 Jan;2(1):46-53. doi: 10.1016/j.jcin.2008.09.011.
We sought to examine the short- and long-term outcomes of blood transfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI).
The short- and long-term consequences of blood transfusion in anemic patients with recent STEMI remain controversial.
We evaluated 30-day, 6-month, and 1-year all-cause mortality among 4,131 STEMI patients enrolled in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial. Patients were categorized according to whether they received a blood transfusion during hospitalization. Cox proportional hazards survival models with transfusion as a time-dependent covariate were conducted for the whole and for the propensity-matched groups. Additionally, a series of sensitivity analyses assessed the magnitude of hidden bias that would need to be present to explain the associations actually observed.
Death at 30 days (13.7% vs. 5.5%), 6 months (19.7% vs. 6.9%), and 1 year (21.8% vs. 8.7%) was significantly higher for transfused patients than for nontransfused patients, respectively. After adjusting for over 25 baseline characteristics, nadir hemoglobin, and propensity score for transfusion, and using transfusion as a time-dependent covariate, transfusion remained significantly associated with increased risk of mortality at 30 days (hazard ratio [HR]: 3.89, 95% confidence interval [CI]: 2.66 to 5.68, p < 0.001), 6 months (HR: 3.63, 95% CI: 2.67 to 4.95, p < 0.001), and 1 year (HR: 3.03, 95% CI: 2.25 to 4.08, p < 0.001). Similar results were observed in the propensity-matched patients.
Blood transfusion is associated with increased short- and long-term mortality in the setting of STEMI.
我们旨在研究 ST 段抬高型心肌梗死（STEMI）患者输血的短期和长期结局。
近期发生 STEMI 的贫血患者输血的短期和长期后果仍存在争议。
我们评估了 GUSTO IIb 试验中纳入的 4131 例 STEMI 患者的 30 天、6 个月和 1 年全因死亡率。根据患者住院期间是否接受输血，将其分为输血组和非输血组。采用 Cox 比例风险生存模型，以输血作为时变协变量，对全组和倾向匹配组进行分析。此外，还进行了一系列敏感性分析，以评估需要存在多大程度的潜在偏倚才能解释实际观察到的关联。
输血组患者 30 天（13.7%比 5.5%）、6 个月（19.7%比 6.9%）和 1 年（21.8%比 8.7%）的死亡率明显高于非输血组。在校正了 25 项以上的基线特征、最低血红蛋白值和输血倾向评分后，并将输血作为时变协变量，输血仍与 30 天（危险比[HR]：3.89，95%置信区间[CI]：2.66 至 5.68，p<0.001）、6 个月（HR：3.63，95%CI：2.67 至 4.95，p<0.001）和 1 年（HR：3.03，95%CI：2.25 至 4.08，p<0.001）的死亡风险增加显著相关。在倾向匹配的患者中也观察到了类似的结果。
在 STEMI 患者中，输血与短期和长期死亡率增加相关。
