Hidri Sinda, Ur Rehman Wajeeh, Gardezi Karam, Shah Jassim Zaheen, Masetti Sai Venkata Siddhartha, Almansouri Naiela E, Maan Arslan, Dave Tirth, Catic Sumeja, Nagoke Simranjeet Singh, Rehman Mohammad Ebad Ur, Cheema Huzaifa Ahmad, Ahmad Adeel, Ahmed Raheel, Selma Abdelhamid Ben, Sabouni Mouhamed Amr, Braiteh Nabil, Yarkoni Alon, Patel Keyoor, Rehman Afzal Ur
Department of Internal Medicine, East Carolina University, Greenville, NC, United States.
Department of Internal Medicine, United Health Services Hospital, Johnson City, NY, United States.
Front Cardiovasc Med. 2025 Apr 24;12:1457400. doi: 10.3389/fcvm.2025.1457400. eCollection 2025.
It is uncertain whether a liberal red blood cell (RBC) transfusion strategy is superior to a restrictive approach in patients with acute coronary syndrome (ACS) and anemia.
We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 for randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in ACS patients with concurrent anemia.
Five RCTs (4,510 patients) were included in this meta-analysis. There was no significant difference between the liberal and restrictive RBC transfusion strategy groups in the risk of major adverse cardiovascular events (MACE) (RR 0.91, 95% CI: 0.68-1.21; = 63%) and all-cause mortality (RR 0.85, 95% CI: 0.72, 1.00; = 0%). A liberal transfusion strategy reduced the risk of myocardial infarction (MI) (RR 0.80, 95% CI: 0.66, 0.98; = 0%). There were no significant differences between the two strategies in the risk of revascularization, heart failure, stroke, cardiac mortality, acute kidney injury or failure, and pneumonia, bacteremia, or infection. Liberal transfusion increased the risk of acute lung injury (RR 8.97, 95% CI: 1.65, 48.65; = 0%).
Our meta-analysis demonstrated that a liberal RBC transfusion strategy reduced the risk of MI and increased the risk of acute lung injury but did not affect other clinical outcomes compared to a restrictive approach in patients with mainly acute MI and anemia. New large-scale multicenter RCTs are required to confirm or refute our findings and provide more reliable results.
PROSPERO (CRD42024506844).
对于急性冠状动脉综合征（ACS）合并贫血患者，宽松的红细胞（RBC）输血策略是否优于限制性输血策略尚不确定。
我们检索了MEDLINE、Embase、Cochrane图书馆和ClinicalTrials.gov，从建库至2024年4月，查找比较ACS合并贫血患者宽松和限制性输血策略的随机对照试验（RCT）。
本荟萃分析纳入了5项RCT（4510例患者）。在主要不良心血管事件（MACE）风险方面，宽松和限制性RBC输血策略组之间无显著差异（风险比[RR]0.91，95%置信区间[CI]：0.68 - 1.21；I² = 63%），全因死亡率方面也无显著差异（RR 0.85，95% CI：0.72，1.00；I² = 0%）。宽松输血策略降低了心肌梗死（MI）风险（RR 0.80，95% CI：0.66，0.98；I² = 0%）。在血运重建、心力衰竭、中风、心脏性死亡、急性肾损伤或衰竭以及肺炎、菌血症或感染风险方面，两种策略无显著差异。宽松输血增加了急性肺损伤风险（RR 8.97，95% CI：1.65，48.65；I² = 0%）。
我们的荟萃分析表明，在主要为急性心肌梗死合并贫血的患者中，与限制性输血策略相比，宽松的RBC输血策略降低了MI风险，但增加了急性肺损伤风险，且未影响其他临床结局。需要新的大规模多中心RCT来证实或反驳我们的发现，并提供更可靠的结果。
PROSPERO（CRD42024506844）
