Impact of Blood Transfusions in Patients Presenting With Anemia and Suspected Acute Coronary Syndrome

      Anemia has been shown to predict adverse events in patients presenting with acute coronary syndromes and non–ST-elevation myocardial infarctions (MIs). Less is known about the value of blood transfusions in this setting. We sought to evaluate the impact of red blood cell transfusions on outcomes. Transfusion in anemic patients admitted with suspected acute coronary syndrome/non–ST-elevation MIs led to a significant increase in 30-day recurrent MI or death (odds ratio 3.05, 95% confidence interval 1.80 to 5.17, p <0.001). This relation persisted after adjusting for significant univariate predictors: hypotension on presentation, pulmonary edema, and increased troponin-I levels (odds ratio 2.57, 95% confidence interval 1.41 to 4.69, p <0.001). In conclusion, the risk versus benefit of transfusion in patients presenting with an acute coronary syndrome needs careful assessment.
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        • Al Falluji N.
        • Lawrence-Nelson J.
        • Kostis J.B.
        • Lacy C.R.
        • Ranjan R.
        • Wilson A.C.
        Effect of anemia on 1-year mortality in patients with acute myocardial infarction.
        Am Heart J. 2002; 144: 636-641
        • Lipsic E.
        • Van der Horst I.C.
        • Voors A.A.
        • Van der Meer P.
        • Nijsten M.W.
        • Van Gilst W.H.
        • Van Veldhuisen D.J.
        • Zijlstra F.
        Hemoglobin levels and 30-day mortality in patients after myocardial infarction.
        Int J Cardiol. 2005; 100: 289-292
        • American College of Physicians
        Practice strategies for elective red blood cell transfusion.
        Ann Intern Med. 1992; 116: 403-406
      1. Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy.
        Anesthesiology. 1996; 84: 732-747
        • Expert Working Group
        Guidelines for red blood cell and plasma transfusions for adults and children.
        CMAJ. 1997; 156: S1-S25
        • Cannon C.P.
        • Battler A.
        • Brindis R.G.
        • Cox J.L.
        • Ellis S.G.
        • Every N.R.
        • Flaherty J.T.
        • Harrington R.A.
        • Krumholz H.M.
        • Simoons M.L.
        • et al.
        American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes.
        J Am Coll Cardiol. 2001; 38: 2114-2130
        • Rao S.V.
        • Jollis J.G.
        • Harrington R.A.
        • Granger C.B.
        • Newby L.K.
        • Armstrong P.W.
        • Moliterno D.J.
        • Lindblad L.
        • Pieper K.
        • Topol E.J.
        • Stamler J.S.
        • Califf R.M.
        Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes.
        JAMA. 2004; 292: 1555-1562
        • Sabatine M.S.
        • Morrow D.A.
        • Giugliano R.P.
        • Burton P.B.
        • Murphy S.A.
        • McCabe C.H.
        • Gibson C.M.
        • Braunwald E.
        Association of hemoglobin levels with clinical outcomes in acute coronary syndromes.
        Circulation. 2005; 111: 2042-2049
        • Yang X.
        • Alexander K.P.
        • Chen A.Y.
        • Roe M.T.
        • Brindis R.G.
        • Rao S.V.
        • Gibler W.B.
        • Ohman E.M.
        • Peterson E.D.
        The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative.
        J Am Coll Cardiol. 2005; 46: 1490-1495
        • Hebert P.C.
        • Yetisir E.
        • Martin C.
        • Blajchman M.A.
        • Wells G.
        • Marshall J.
        • Tweeddale M.
        • Pagliarello G.
        • Schweitzer I.
        Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?.
        Crit Care Med. 2001; 29: 227-234
        • Wu W.C.
        • Rathore S.S.
        • Wang Y.
        • Radford M.J.
        • Krumholz H.M.
        Blood transfusion in elderly patients with acute myocardial infarction.
        N Engl J Med. 2001; 345: 1230-1236
        • Perrotta P.L.
        • Snyder E.L.
        Non-infectious complications of transfusion therapy.
        Blood Rev. 2001; 15: 69-83
        • Weed R.I.
        • LaCelle P.L.
        • Merrill E.W.
        Erythrocyte metabolism and cellular deformability.
        Vox Sang. 1969; 17: 32-33
        • Longster G.H.
        • Buckley T.
        • Sikorski J.
        • Derrick Tovey L.A.
        Scanning electron microscope studies of red cell morphology.
        Vox Sang. 1972; 22: 161-170
        • Welch H.G.
        • Meehan K.R.
        • Goodnough L.T.
        Prudent strategies for elective red blood cell transfusion.
        Ann Intern Med. 1992; 116: 393-402