Impact of blood transfusion on in-hospital myocardial infarctions according to patterns of acute coronary syndrome: Insights from the BleeMACS registry

详细信息    查看全文

• 作者：Sebastiano Gili^a ; ^{sebastiano.gili@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Fabrizio D'Ascenzo^a ; Marco Francesco Lococo^a ; Claudio Moretti^a ; Fiorenzo Gaita^a ; Sergio Raposeiras-Roub&iacute ; n^b ; Emad Abu-Assi^b ; Jose Paulo Simao Henriques^c ; Jorge Saucedo^d ; Jos&eacute ; Ram&oacute ; n Gonz&aacute ; lez-Juanatey^e ; Stephen B. Wilton^f ; Wouter J. Kikkert^c ; Iv&aacute ; n Nuñ ; ez-Gil^g ; Albert Ariza-Sole^h ; Xiantao Songⁱ ; Dimitrios Alexopoulos^j ; Christoph Liebetrau^k ; Tetsuma Kawaji^l ; Zenon Huczek^m ; Shao-Ping Nieⁿ ; Toshiharu Fujii^o ; Luis Correia^p ; Masa-aki Kawashiri^q ; Jos&eacute ; Mar&iacute ; a Garc&iacute ; a-Acuñ ; a^b ; Danielle Southern^f ; Emilio Alfonso^g ; Bel&eacute ; n Terol^g ; Alberto Garay^h ; Dongfeng Zhangⁱ ; Yalei Chenⁱ ; Ioanna Xanthopoulou^j ; Neriman Osman^k ; Helge Mö ; llmann^k ; Hiroki Shiomi^l ; Silvia Scarano^a ; Michal Kowara^m ; Krzysztof Filipiak^m ; Xiao Wangⁿ ; Yan Yanⁿ ; Jing-Yao Fanⁿ ; Yuji Ikari^o ; Takuya Nakahashi^q ; Kenji Sakata^q ; Masakazu Yamagishi^q ; Oliver Kalpak^r ; Sasko Kedev^r
• 关键词：ACS ; acute coronary syndrome ; BTs ; blood transfusions ; CV ; cardiovascular ; DAPT ; double anti-platelet therapy ; Hb ; hemoglobin ; NSTE-ACS ; non-ST segment elevation acute coronary syndrome ; NSTEMI ; non-ST segment elevation myocardial infarction ; OAC ; oral anticoagulation ; PAD ; peripheral arterial disease ; PCI ; percutaneous coronary intervention ; reAMI ; recurrent acute myocardial infarction ; STEMI ST ; segment elevation myocardial infarction ; UA ; unstable angina
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 October 2016
• 年：2016
• 卷：221
• 期：Complete
• 页码：364-370
• 全文大小：473 K

文摘

Blood transfusions (BTs) may worsen the prognosis of patients affected by acute coronary syndromes (ACS), although few data detail their impact on short-term events according to clinical presentation (ST Segment Elevation Myocardial Infarction, STEMI vs. Non-ST Segment Elevation ACS, NSTE-ACS).

Methods

Patients undergoing percutaneous coronary intervention (PCI) for ACS, with data on BTs, were selected from the BleeMACS registry. The primary end point was the incidence of myocardial infarction during hospitalization (reAMI), the secondary end-points were 30-day mortality and the combined end-point of 30-day mortality and reAMI. Sensitivity analyses were performed according to clinical presentation (STEMI vs. NSTE-ACS).

Results

Overall, 13,975 patients were included: mean age was 64.1 years, 10,651 (76.2%) were male and 7711 (55.2%) had STEMI. BTs were administered during hospitalization to 465 (3.3%) patients, who were older and presented a more relevant burden of risk factors. The primary end-point of reAMI occurred in 197 (1.4%) patients, of whom 102 (1.1%) with STEMI. After controlling for confounding variables, BTs independently predicted the primary end-point reAMI in patients admitted for STEMI (OR 4.059, 95% CI 2244–7.344) and not in those admitted for NSTE-ACS. Moreover, BTs independently related to 30-day mortality in STEMI and NSTE-ACS patients and to the composite of 30-day mortality and reAMI in STEMI patients.

Conclusions

In patients undergoing PCI for ACS, BTs increase the risk of reAMI only in those admitted for STEMI, and not in those with NSTE-ACS. These results may help physicians to choose appropriate BT administration according to the admission diagnosis.