Document Detail


Prognostic impact of blood transfusion after primary angioplasty for acute myocardial infarction: analysis from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) Trial.
MedLine Citation:
PMID:  19628185     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine the relationship between red blood cell (RBC) transfusion and clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
BACKGROUND: The implications of RBC transfusion in patients undergoing primary PCI for AMI have not been evaluated.
METHODS: Clinical outcomes of patients from the prospective, randomized CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial were analyzed by administration of in-hospital RBC transfusion not related to coronary artery bypass surgery.
RESULTS: Of 2,060 randomized patients, 82 (3.98%) received RBC transfusion during the index hospitalization, including 33 (1.60%) with moderate/severe bleeding and 49 (2.38%) without overt major bleeding. Transfusion was independently associated with baseline anemia (odds ratio [95% confidence interval]: 4.44 [2.60 to 7.58], p < 0.0001), older age (1.03 [1.01 to 1.06], p = 0.002), triple-vessel disease (2.54 [1.47 to 4.38], p = 0.0008), and female sex (1.04 [1.02 to 1.06], p = 0.0008). Patients transfused versus not transfused had significantly higher rates of 1-year mortality (23.9% vs. 3.4%), disabling stroke (2.5% vs. 0.5%), reinfarction (7.0% vs. 2.2%), and composite major adverse cardiac events (41.0% vs. 16.6%) (all p values < 0.01). After multivariable adjustment for potential confounders including transfusion propensity, RBC transfusion was independently associated with mortality at 30 days (hazards ratio: 4.71, p = 0.0005) and 1 year (hazards ratio: 3.16, p = 0.0005).
CONCLUSIONS: An RBC transfusion after primary PCI in AMI may be harmful, which is consistent with the findings from other studies after PCI in the noninfarct setting. Alternatively, RBC transfusion may be a marker of markedly increased risk. Randomized studies are warranted to determine the optimal threshold for RBC transfusion in patients with AMI undergoing mechanical reperfusion therapy.
Authors:
Eugenia Nikolsky; Roxana Mehran; H Mehrdad Sadeghi; Cindy L Grines; David A Cox; Eulogio Garcia; James E Tcheng; John J Griffin; Giulio Guagliumi; Thomas Stuckey; Mark Turco; Martin Fahy; Alexandra J Lansky; Gregg W Stone
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  2     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-24     Completed Date:  2009-10-02     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  624-32     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Anemia / complications
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation,  mortality
Antibodies, Monoclonal / therapeutic use*
Erythrocyte Transfusion / adverse effects*,  mortality
Female
Heart Diseases / etiology
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction / mortality,  radiography,  therapy*
Odds Ratio
Platelet Aggregation Inhibitors / therapeutic use*
Proportional Hazards Models
Prospective Studies
Recurrence
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Stroke / etiology
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; X85G7936GV/abciximab
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2009 Jul;2(7):633-5   [PMID:  19628186 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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