title: Blood transfusion, bleeding, anemia, and survival in patients with acute myocardial infarction: FAST-MI registry.
abstract: BACKGROUND
  An association between transfusion during index hospitalization and increased subsequent mortality has been reported in acute myocardial infarction (AMI). Whether this reflects the prognostic role of transfusion per se, or the impact of the index event leading to transfusion, remains unclear. We sought to evaluate the impact of transfusion on mortality in patients with AMI.
  
  
  METHODS
  Using the nationwide FAST-MI 2005 AMI registry, we recorded anemia on admission, Thrombolysis in Myocardial Infarction major or minor bleeding, and transfusions during hospital stay. Multivariable analyses were performed to identify independent predictors of in-hospital and 5-year mortality. Cohorts of patients matched for propensity to receive transfusion were compared.
  
  
  RESULTS
  Among 3541 patients with AMI, 827 (23.4%) had anemia on admission, 114 (3.2%) had minor or major bleeding, and 151 (4.3%) underwent transfusion. After multivariable analysis, both anemia and bleeding were independently associated with 5-year mortality (hazard ratio [HR] 1.4, 95% CI 1.2-1.6 and HR 1.4, 95% CI 1.1-1.8, respectively), whereas transfusion did not appear to be an independent predictor (HR 1.1, 95% CI 0.8-1.5). Mortality at 5 years did not differ between cohorts matched for propensity to receive transfusion.
  
  
  CONCLUSIONS
  In this cohort, anemia on admission and bleeding during hospitalization were both associated with increased 5-year mortality in patients with myocardial infarction. Conversely, transfusion per se was not associated with lower survival. Further work is needed to clarify the optimal transfusion strategy in patients with bleeding or anemia and myocardial infarction.
authors.affiliation: Département Hospitalo-Universitaire FIRE, APHP, Hôpital Bichat, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U-1148, Paris, France. Electronic address: gregory.ducrocq@bch.aphp.fr.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.affiliation: APHP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: Département Hospitalo-Universitaire FIRE, APHP, Hôpital Bichat, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U-1148, Paris, France; NHLI, Imperial College, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: APHP, Hôpital Lariboisière, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Centre Hospitalier de Langres, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Martelet
authors.affiliation: Hôpital Ambroise Paré, Paris, France.
authors.forename: Carma
authors.initials: C
authors.lastname: Karam
authors.affiliation: CHU Besançon, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: APHP, Hôpital Saint Antoine, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: APHP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D001803:Blood Transfusion; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends