Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany.
Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
Int J Cardiol. 2022 Nov 15;367:1-10. doi: 10.1016/j.ijcard.2022.08.052. Epub 2022 Aug 31.
The role of erythrocytes in the acute coronary syndrome (ACS) is complex. The aim of this review in terms of PICO (P: patients; I: intervention; C: comparison; O: outcome) was to summarize systematic reviews in patients (P) with acute coronary syndrome, evaluating the effects of (I) 1) iron deficiency, 2) administration of an erythropoiesis-stimulating agent (ESA), 3) anemia on admission, 4) red blood cell transfusion, 5) a restrictive transfusion strategy in comparison (C) to 1) no iron deficiency, 2) no ESA 3) no anemia on admission, 4) no red blood cell transfusion, 5) a liberal transfusion strategy on mortality (O).
We used AMSTAR2 to assess the methodological quality of systematic reviews and grade the available research. The primary endpoint was all-cause mortality.
Using the data from 2,787,005 patients, the following conditions were associated with worse outcome in patients with ACS: anemia on admission (RR 2.08 95%CI 1.70-2.55) and transfusion (1.93 95%CI 1.12-3.34) of red blood cells. A liberal transfusion (RR 0.86 95%CI 0.70-1-05), administration of ESA (RR 0.55 95%CI 0.22-1.33) and iron deficiency (OR 1.24 95%CI 0.12-13.13) were not associated with altered all-cause mortality.
Patients suffering from ACS and anemia on admission are at particular risk for adverse outcome. There is evidence of associations between adverse outcomes and receiving red blood cell transfusions.
红细胞在急性冠状动脉综合征（ACS）中的作用较为复杂。本综述采用 PICO（患者 P、干预 I、比较 C、结局 O）方法，旨在总结评估急性冠状动脉综合征患者（P）中以下内容的系统综述：（I）1）铁缺乏症、2）促红细胞生成刺激剂（ESA）的应用、3）入院时贫血、4）红细胞输注、5）与 1）无铁缺乏症、2）无 ESA、3）入院时无贫血、4）无红细胞输注、5）宽松输血策略（C）相比的限制性输血策略（O）对死亡率的影响。
我们使用 AMSTAR2 评估系统综述的方法学质量，并对现有研究进行分级。主要终点为全因死亡率。
使用来自 2787005 名患者的数据，以下情况与 ACS 患者预后较差相关：入院时贫血（RR 2.08，95%CI 1.70-2.55）和输血（RR 1.93，95%CI 1.12-3.34）。输血策略较宽松（RR 0.86，95%CI 0.70-1.05）、ESA 应用（RR 0.55，95%CI 0.22-1.33）和铁缺乏症（OR 1.24，95%CI 0.12-13.13）与全因死亡率无变化相关。
患有 ACS 和入院时贫血的患者发生不良结局的风险特别高。有证据表明，输血与不良结局之间存在关联。
