Nikolsky Eugenia, Mehran Roxana, Sadeghi H Mehrdad, Grines Cindy L, Cox David A, Garcia Eulogio, Tcheng James E, Griffin John J, Guagliumi Giulio, Stuckey Thomas, Turco Mark, Fahy Martin, Lansky Alexandra J, Stone Gregg W
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10032, USA.
JACC Cardiovasc Interv. 2009 Jul;2(7):624-32. doi: 10.1016/j.jcin.2009.05.004.
We sought to determine the relationship between red blood cell (RBC) transfusion and clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
The implications of RBC transfusion in patients undergoing primary PCI for AMI have not been evaluated.
Clinical outcomes of patients from the prospective, randomized CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial were analyzed by administration of in-hospital RBC transfusion not related to coronary artery bypass surgery.
Of 2,060 randomized patients, 82 (3.98%) received RBC transfusion during the index hospitalization, including 33 (1.60%) with moderate/severe bleeding and 49 (2.38%) without overt major bleeding. Transfusion was independently associated with baseline anemia (odds ratio [95% confidence interval]: 4.44 [2.60 to 7.58], p < 0.0001), older age (1.03 [1.01 to 1.06], p = 0.002), triple-vessel disease (2.54 [1.47 to 4.38], p = 0.0008), and female sex (1.04 [1.02 to 1.06], p = 0.0008). Patients transfused versus not transfused had significantly higher rates of 1-year mortality (23.9% vs. 3.4%), disabling stroke (2.5% vs. 0.5%), reinfarction (7.0% vs. 2.2%), and composite major adverse cardiac events (41.0% vs. 16.6%) (all p values < 0.01). After multivariable adjustment for potential confounders including transfusion propensity, RBC transfusion was independently associated with mortality at 30 days (hazards ratio: 4.71, p = 0.0005) and 1 year (hazards ratio: 3.16, p = 0.0005).
An RBC transfusion after primary PCI in AMI may be harmful, which is consistent with the findings from other studies after PCI in the noninfarct setting. Alternatively, RBC transfusion may be a marker of markedly increased risk. Randomized studies are warranted to determine the optimal threshold for RBC transfusion in patients with AMI undergoing mechanical reperfusion therapy.
我们试图确定接受急性心肌梗死（AMI）直接经皮冠状动脉介入治疗（PCI）患者的红细胞（RBC）输注与临床结局之间的关系。
尚未评估RBC输注对接受AMI直接PCI患者的影响。
通过给予与冠状动脉搭桥手术无关的住院期间RBC输注，分析前瞻性随机CADILLAC（抑制晚期血管成形术并发症的阿昔单抗和器械对照研究）试验患者的临床结局。
在2060例随机分组的患者中，82例（3.98%）在首次住院期间接受了RBC输注，其中33例（1.60%）有中度/重度出血，49例（2.38%）无明显大出血。输血与基线贫血（比值比[95%置信区间]：4.44[2.60至7.58]，p<0.0001）、老年（1.03[1.01至1.06]，p = 0.002）、三支血管病变（2.54[1.47至4.38]，p = 0.0008）和女性（1.04[1.02至1.06]，p = 0.0008）独立相关。接受输血与未接受输血的患者1年死亡率（23.9%对3.4%）、致残性卒中（2.5%对0.5%）、再梗死（7.0%对2.2%）和复合主要不良心脏事件（41.0%对16.6%）发生率显著更高（所有p值<0.01）。在对包括输血倾向在内的潜在混杂因素进行多变量调整后，RBC输注与30天死亡率（风险比：4.71，p = 0.0005）和1年死亡率（风险比：3.16，p = 0.0005）独立相关。
AMI直接PCI后输注RBC可能有害，这与非梗死情况下PCI后其他研究的结果一致。或者，RBC输注可能是风险显著增加的一个标志。有必要进行随机研究以确定接受机械再灌注治疗的AMI患者RBC输注的最佳阈值。
