Red blood cell storage duration and mortality in patients undergoing percutaneous coronary intervention.
BACKGROUND
Blood transfusion has been associated with an increased mortality in patients undergoing percutaneous coronary intervention (PCI). Although the reasons for this remain unclear, it may be related to the structural and functional changes occurring within red blood cells (RBCs) during storage. We investigated whether RBC storage duration was associated with mortality in patients requiring transfusion after PCI.


METHODS
We collected data on all RBC transfusions occurring within 10 days of PCI (excluding those related to cardiac surgery) using the British Columbia Cardiac Registry and Central Transfusion Registry. Transfusion details were analyzed according to 30-day survival.


RESULTS
From a total of 32,580 patients undergoing PCI, 909 (2.8%) patients received RBCs with a mean storage duration of 25 +/- 10 days. In these 909 patients, mean transfusion volumes were lower in survivors (2.8 +/- 2.1 vs 3.8 +/- 2.9 U, P = .002) than those who died within 30 days. In a multivariate analysis to adjust for baseline risk, mean RBC storage age (HR 1.02 [95% CI 1.01-1.04], P = .002) and transfusion volume (HR 1.26 [95% CI 1.18-1.34], P < .001) both predicted 30-day mortality. Transfused patients who received only older blood (RBC min age >28 days) appeared to be at greater risk of death (HR 2.49 [95% CI 1.45-4.25], P = .001).


CONCLUSIONS
Red blood cell transfusion is associated with increased 30-day mortality in patients undergoing PCI. Although current transfusion practice permits RBC storage for up to 42 days, the use of older red cells may pose an additional hazard to this patient group.
Robinson
Simon D
SD
Victoria Heart Institute Foundation, Victoria BC, Canada. sdrobinson@vhif.org
Janssen
Christian
C
Fretz
Eric B
EB
Berry
Brian
B
Chase
Alex J
AJ
Siega
Anthony Della
AD
Carere
Ronald G
RG
Fung
Anthony
A
Simkus
Gerald
G
Klinke
W Peter
WP
Hilton
J David
JD
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001793:Blood Preservation; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D004912:Erythrocytes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D013997:Time Factors