title: Impact of blood transfusion on in-hospital myocardial infarctions according to patterns of acute coronary syndrome: Insights from the BleeMACS registry.
abstract: BACKGROUND
  Blood transfusions (BTs) may worsen the prognosis of patients affected by acute coronary syndromes (ACS), although few data detail their impact on short-term events according to clinical presentation (ST Segment Elevation Myocardial Infarction, STEMI vs. Non-ST Segment Elevation ACS, NSTE-ACS).
  
  
  METHODS
  Patients undergoing percutaneous coronary intervention (PCI) for ACS, with data on BTs, were selected from the BleeMACS registry. The primary end point was the incidence of myocardial infarction during hospitalization (reAMI), the secondary end-points were 30-day mortality and the combined end-point of 30-day mortality and reAMI. Sensitivity analyses were performed according to clinical presentation (STEMI vs. NSTE-ACS).
  
  
  RESULTS
  Overall, 13,975 patients were included: mean age was 64.1years, 10,651 (76.2%) were male and 7711 (55.2%) had STEMI. BTs were administered during hospitalization to 465 (3.3%) patients, who were older and presented a more relevant burden of risk factors. The primary end-point of reAMI occurred in 197 (1.4%) patients, of whom 102 (1.1%) with STEMI. After controlling for confounding variables, BTs independently predicted the primary end-point reAMI in patients admitted for STEMI (OR 4.059, 95% CI 2244-7.344) and not in those admitted for NSTE-ACS. Moreover, BTs independently related to 30-day mortality in STEMI and NSTE-ACS patients and to the composite of 30-day mortality and reAMI in STEMI patients.
  
  
  CONCLUSIONS
  In patients undergoing PCI for ACS, BTs increase the risk of reAMI only in those admitted for STEMI, and not in those with NSTE-ACS. These results may help physicians to choose appropriate BT administration according to the admission diagnosis.
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy. Electronic address: sebastiano.gili@gmail.com.
authors.forename: Sebastiano
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authors.lastname: Gili
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fabrizio
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authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Marco Francesco
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authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
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authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fiorenzo
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authors.affiliation: University Hospital Álvaro Cunqueiro, Vigo, Spain.
authors.forename: Sergio
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authors.affiliation: University Academic Medical Center, Amsterdam, The Netherlands.
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authors.affiliation: University Clinical Hospital of Santiago de Compostela, Spain.
authors.forename: José Ramón
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authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Canada.
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authors.affiliation: University Academic Medical Center, Amsterdam, The Netherlands.
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authors.forename: Xiantao
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authors.forename: Dimitrios
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authors.lastname: Alexopoulos
authors.affiliation: Kerckhoff Heart and Thorax Center, Frankfurt, Germany.
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authors.forename: José María
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authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy; D001803:Blood Transfusion / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D065227:Transfusion Reaction
keywords: Acute coronary syndromes; Blood transfusion; Recurrent myocardial infarction