Impact of blood transfusion on short- and long-term mortality in patients with ST-segment elevation myocardial infarction.
OBJECTIVE
We sought to examine the short- and long-term outcomes of blood transfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
The short- and long-term consequences of blood transfusion in anemic patients with recent STEMI remain controversial.


METHODS
We evaluated 30-day, 6-month, and 1-year all-cause mortality among 4,131 STEMI patients enrolled in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial. Patients were categorized according to whether they received a blood transfusion during hospitalization. Cox proportional hazards survival models with transfusion as a time-dependent covariate were conducted for the whole and for the propensity-matched groups. Additionally, a series of sensitivity analyses assessed the magnitude of hidden bias that would need to be present to explain the associations actually observed.


RESULTS
Death at 30 days (13.7% vs. 5.5%), 6 months (19.7% vs. 6.9%), and 1 year (21.8% vs. 8.7%) was significantly higher for transfused patients than for nontransfused patients, respectively. After adjusting for over 25 baseline characteristics, nadir hemoglobin, and propensity score for transfusion, and using transfusion as a time-dependent covariate, transfusion remained significantly associated with increased risk of mortality at 30 days (hazard ratio [HR]: 3.89, 95% confidence interval [CI]: 2.66 to 5.68, p < 0.001), 6 months (HR: 3.63, 95% CI: 2.67 to 4.95, p < 0.001), and 1 year (HR: 3.03, 95% CI: 2.25 to 4.08, p < 0.001). Similar results were observed in the propensity-matched patients.


CONCLUSIONS
Blood transfusion is associated with increased short- and long-term mortality in the setting of STEMI.
Shishehbor
Mehdi H
MH
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. shishem@gmail.com
Madhwal
Surabhi
S
Rajagopal
Vivek
V
Hsu
Amy
A
Kelly
Peter
P
Gurm
Hitinder S
HS
Kapadia
Samir R
SR
Lauer
Michael S
MS
Topol
Eric J
EJ
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy; D000368:Aged; D000740:Anemia / Q000401:mortality* / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014481:United States