Allonen Jaakko, Nieminen Markku S, Hiippala Seppo, Sinisalo Juha
Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
Am J Cardiol. 2018 Jun 15;121(12):1496-1504. doi: 10.1016/j.amjcard.2018.02.035. Epub 2018 Mar 13.
Registry studies have associated red blood cell (RBC) transfusion with increased in-hospital mortality in patients with acute coronary syndrome (ACS). The impact on long-term mortality after 1-year follow-up remains unknown. Consecutive patients with ACS (n = 2,009) of a prospective Genetic Predisposition of Coronary Artery Disease cohort were followed for a median of 8.6 years (95% confidence interval [CI] 8.59 to 8.69). After discharge, 1,937 (96%) patients survived for over 30 days. Of those survivors, a subgroup of previously transfusion-naïve patients 85/1,937 (4.4%) who had received at least 1 RBC transfusion during hospitalization were compared with 1,278/1,937 patients (66.0%) who had not received any transfusion either during the hospitalization or the entire follow-up. Unadjusted long-term mortality was significantly higher in the patients transfused with RBC compared with their counterparts not transfused with RBC (58.8% vs 20.3%, p <0.001). The results remained significant for hazard ratio (HR) 1.91, 95% CI 1.39 to 2.63, p <0.001, after multivariate Cox proportional hazards model analysis and were similar after 1-year landmark analysis (HR 1.90, 95% CI 1.34 to 2.70, p <0.001). The higher all-cause mortality was largely explained by cancer mortality (15.3% vs 4.1%, p <0.001) and cardiovascular mortality (34.1% vs 12.1%, p <0.001). After 1:1 propensity score matching (n = 65 vs 65), the association of RBC transfusion with worse survival remained significant (HR 2.70, 95% CI 1.48 to 4.95, p = 0.001). Inverse probability weighted Cox analyses turned out similar results (HR 2.07, 95% CI 1.38 to 3.11, p <0.001). In conclusion, the strong association of need for RBC transfusion with increased mortality continued for patients with ACS even after a 1-year follow-up.
登记研究表明，急性冠状动脉综合征（ACS）患者接受红细胞（RBC）输血与住院死亡率增加有关。1年随访后对长期死亡率的影响尚不清楚。对冠状动脉疾病队列前瞻性遗传易感性研究中的连续ACS患者（n = 2,009）进行了中位数为8.6年的随访（95%置信区间[CI]8.59至8.69）。出院后，1,937名（96%）患者存活超过30天。在这些幸存者中，将住院期间至少接受1次RBC输血的1,937名既往未输血患者中的85名（4.4%）亚组与住院期间或整个随访期间未接受任何输血的1,278名患者（66.0%）进行了比较。与未接受RBC输血的患者相比，接受RBC输血的患者未调整的长期死亡率显著更高（58.8%对20.3%，p<0.001）。多变量Cox比例风险模型分析后，风险比（HR）为1.91，95%CI为1.39至2.63，p<0.001，结果仍然显著，1年标志性分析后结果相似（HR 1.90，95%CI 1.34至2.70，p<0.001）。较高的全因死亡率主要由癌症死亡率（15.3%对4.1%，p<0.001）和心血管死亡率（34.1%对12.1%，p<0.001）解释。在1:1倾向评分匹配后（n = 65对65），RBC输血与较差生存率之间的关联仍然显著（HR 2.70，95%CI 1.48至4.95，p = 0.001）。逆概率加权Cox分析得出了类似的结果（HR 2.07，95%CI 1.38至3.11，p<0.001）。总之，即使在1年随访后，ACS患者中RBC输血需求与死亡率增加之间的强烈关联仍然存在。
