title: Impact of blood transfusion on short- and long-term mortality in patients with ST-segment elevation myocardial infarction.
abstract: 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.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. shishem@gmail.com
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
authors.forename: Surabhi
authors.initials: S
authors.lastname: Madhwal
authors.forename: Vivek
authors.initials: V
authors.lastname: Rajagopal
authors.forename: Amy
authors.initials: A
authors.lastname: Hsu
authors.forename: Peter
authors.initials: P
authors.lastname: Kelly
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: 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