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Blood transfusion and ischaemic outcomes according to anemia and bleeding in patients with non-ST-segment elevation acute coronary syndromes: Insights from the TAO randomized clinical trial.
Deharo, P; Ducrocq, G; Bode, C; Cohen, M; Cuisset, T; Mehta, S R; Pollack, C V; Wiviott, S D; Rao, S V; Jukema, J W; Erglis, A; Moccetti, T; Elbez, Y; Steg, P G.
Afiliación
  • Deharo P; Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.
  • Ducrocq G; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.
  • Bode C; Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany.
  • Cohen M; Rutgers-New Jersey medical school, Newark, New Jersey, USA; Newark Beth Israel medical centre, Newark, New Jersey, USA.
  • Cuisset T; Département de Cardiologie, CHU Timone, Marseille F-13385, France.
  • Mehta SR; McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Pollack CV; Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  • Wiviott SD; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Rao SV; Department of Cardiology, Duke Clinical Research Institute, Durham, NC, USA.
  • Jukema JW; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Netherlands Heart Institute, Utrecht, the Netherlands.
  • Erglis A; University of Latvia, Pauls Stradins Clinical University Hospita, Riga, Latvia.
  • Moccetti T; Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, 6900 Lugano, Switzerland.
  • Elbez Y; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.
  • Steg PG; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France; National Heart and Lung Ins
Int J Cardiol ; 318: 7-13, 2020 Nov 01.
Article en En | MEDLINE | ID: mdl-32590084
BACKGROUND: The benefits and risks of blood transfusion in patients with acute myocardial infarction who are anemic or who experience bleeding are debated. We sought to study the association between blood transfusion and ischemic outcomes according to haemoglobin nadir and bleeding status in patients with NST-elevation myocardial infarction (NSTEMI). METHODS: The TAO trial randomized patients with NSTEMI and coronary angiogram scheduled within 72h to heparin plus eptifibatide versus otamixaban. After exclusion of patients who underwent coronary artery bypass surgery, patients were categorized according to transfusion status considering transfusion as a time-varying covariate. The primary ischemic outcome was the composite of all-cause death or MI within 180 days of randomization. Subgroup analyses were performed according to pre-transfusion hemoglobin nadir and bleeding status. RESULTS: 12,547 patients were enrolled. Among these, blood transfusion was used in 489 (3.9%) patients. Patients who received transfusion had a higher rate of death or MI (29.9% vs. 8.1%, p<0.01). This excess risk persisted after adjustment on GRACE score and nadir of hemoglobin (HR 3.36 95%CI 2.63-4.29 p<0.01). Subgroup analyses showed that blood transfusion was associated with a higher risk in patients without overt bleeding (adjusted HR 6.25 vs. 2.85; p-interaction 0.001) as well as in those with hemoglobin nadir > 9.0 g/dl (HR 4.01; p-interaction<0.0001). CONCLUSION: In patients with NSTEMI, blood transfusion was associated with an overall increased risk of ischaemic events. However, this was mainly driven by patients without overt bleeding and those hemoglobin nadir > 9.0g/dl. This suggests possible harm of transfusion in those groups.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea / Anemia Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Humans Idioma: En Revista: Int J Cardiol Año: 2020 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea / Anemia Tipo de estudio: Clinical_trials / Diagnostic_studies Límite: Humans Idioma: En Revista: Int J Cardiol Año: 2020 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Países Bajos