Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
BMC Cardiovasc Disord. 2024 Sep 18;24(1):498. doi: 10.1186/s12872-024-04151-z.
There are no clear recommendations for optimal transfusion thresholds for patients with coronary artery disease who undergo noncardiac surgery. By comparing restrictive and liberal transfusion strategies for coronary artery disease combined with hip surgery, this study hopes to provide recommendations for transfusion strategies in this special population.
A total of 805 patients from the FOCUS trial (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) with coronary artery disease combined with hip surgery were divided into two groups based on transfusion thresholds: restricted transfusion (a hemoglobin level of 8 g/deciliter) and liberal transfusion (a hemoglobin threshold of 10 g/deciliter). The primary outcome of this study was a composite endpoint including in-hospital death, myocardial infarction, unstable angina, and acute heart failure. The secondary endpoints included other in-hospital adverse events and 30- and 60-day follow-up events. Analyses were performed by intention to treat.
Except for the proportion of congestive heart failure patients, the baseline levels of the two groups were comparable. The median number of transfusion units in the liberal transfusion group was 2 units, and the median transfusion volume in the restricted transfusion group was 0 units. The primary outcome was not significantly different between the two groups (9.2% vs. 9.4%, p = 0.91). The incidence of in-hospital myocardial infarction events was lower in the liberal transfusion group than in the restricted transfusion group (3.2% vs. 6.2%) (OR = 0.51, P = 0.048). The remaining in-hospital endpoint events, except for myocardial infarction, were not significantly different between the two groups. The 30-day and 60-day endpoints of death and inability to walk independently were not significantly different between the two groups, with ORs (95% CI) of 1.00 (0.75-1.31) and 1.06 (0.80-1.41), respectively. We also found no interaction between transfusion strategies and factors such as age, sex, or multiple underlying comorbidities at the 60-day follow-up.
There was no significant difference in the in-hospital, 30-day or 60-day outcome endpoints between the two groups. However, this study demonstrated that a liberal transfusion strategy tends to reduce the incidence of in-hospital myocardial infarction events in patients with coronary artery disease combined with hip surgery compared to a restrictive transfusion strategy. More high-quality studies should be designed to investigate the optimal transfusion threshold in patients with coronary artery disease treated without cardiac surgery.
对于接受非心脏手术的冠心病患者，目前尚无明确的最佳输血阈值推荐。本研究通过比较冠心病合并髋关节手术患者的限制性输血策略和宽松性输血策略，旨在为该特殊人群的输血策略提供建议。
共有 805 例来自 FOCUS 试验（接受髋关节骨折修复手术的心血管患者输血触发试验）的患者合并冠心病和髋关节手术，根据输血阈值分为两组：限制性输血（血红蛋白水平 8 g/dL）和宽松性输血（血红蛋白阈值 10 g/dL）。本研究的主要终点是包括院内死亡、心肌梗死、不稳定型心绞痛和急性心力衰竭在内的复合终点。次要终点包括其他院内不良事件和 30 天及 60 天随访事件。分析采用意向治疗。
除充血性心力衰竭患者的比例外，两组的基线水平相当。宽松输血组的中位输血量为 2 单位，限制输血组的中位输血量为 0 单位。两组主要终点无显著差异（9.2%比 9.4%，P=0.91）。宽松输血组院内心肌梗死发生率低于限制输血组（3.2%比 6.2%）（OR=0.51，P=0.048）。除心肌梗死外，两组其余院内终点事件无显著差异。两组 30 天和 60 天的死亡和无法独立行走终点均无显著差异，OR（95%CI）分别为 1.00（0.75-1.31）和 1.06（0.80-1.41）。我们还发现，在 60 天随访时，输血策略与年龄、性别或多种基础合并症等因素之间没有相互作用。
两组患者的院内、30 天或 60 天结局终点均无显著差异。然而，本研究表明，与限制性输血策略相比，冠心病合并髋关节手术患者采用宽松性输血策略可降低院内心肌梗死事件的发生率。应设计更多高质量的研究来探讨未接受心脏手术的冠心病患者的最佳输血阈值。
