Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France.
Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), AP-HP, Hôpital St Antoine, Sorbonne-Université, French Alliance for Cardiovascular Trials (FACT), Paris, France.
Can J Cardiol. 2024 Sep;40(9):1705-1714. doi: 10.1016/j.cjca.2024.02.013. Epub 2024 Feb 24.
Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI).
We used data from the randomized REALITY trial. HF was defined as history of HF or Killip class > 1 at randomization. Primary outcome was major adverse cardiovascular events (MACE): composite of all-cause death, nonrecurrent AMI, stroke, or emergency revascularization prompted by ischemia at 30 days.
Among 658 randomized patients, 311 (47.3%) had HF. Patients with HF had higher rates of MACE at 30 days and 1 year and higher rates of nonfatal new-onset HF. There was no interaction between HF and effect of randomized assignment on the primary outcome or nonfatal new-onset HF. A liberal transfusion strategy was associated with increased all-cause death at 30 days and at 1 year in patients with HF (P = 0.009 and P = 0.049, respectively). The main numerical difference in cause of death between restrictive and liberal strategies was death by HF at 30 days (4 vs 11).
HF is frequent in patients with AMI and anemia and is associated with higher risk of MACE (including all-cause death) and nonfatal new-onset HF. Although there was no interaction of HF with effect of transfusion strategy on MACE, a liberal transfusion strategy was associated with higher all-cause death that appears driven by a higher risk of early death caused by HF.
NCT02648113.
红细胞输注可导致液体超负荷。我们评估了基线时心力衰竭（HF）与输血策略对急性心肌梗死（AMI）结局的相互作用。
我们使用了随机 REALITY 试验的数据。HF 定义为随机分组时存在 HF 病史或 Killip 分级>1。主要终点是主要不良心血管事件（MACE）：全因死亡、非复发性 AMI、卒中和缺血引起的 30 天紧急血运重建的复合终点。
在 658 例随机患者中，311 例（47.3%）有 HF。HF 患者在 30 天和 1 年时的 MACE 发生率更高，新发非致命性 HF 的发生率也更高。HF 与随机分组对主要结局或新发非致命性 HF 的影响之间没有相互作用。在 HF 患者中，自由输血策略与 30 天和 1 年时的全因死亡率增加相关（分别为 P=0.009 和 P=0.049）。限制和自由输血策略之间导致死亡率差异的主要原因是 30 天时 HF 导致的死亡（4 例 vs 11 例）。
AMI 和贫血患者中 HF 较为常见，与更高的 MACE（包括全因死亡）和新发非致命性 HF 风险相关。尽管 HF 与输血策略对 MACE 的影响之间没有相互作用，但自由输血策略与更高的全因死亡率相关，这似乎是由 HF 导致的早期死亡风险增加所驱动。
NCT02648113。
