Red blood cell transfusion in patients with ST-elevation myocardial infarction—a meta-analysis of more than 21,000 patients

Abstract

BackgroundRed blood cell transfusion remains controversial in patients with acute coronary syndromes and particularly in patients with ST-elevation myocardial infarction (STEMI).MethodsWe systematically searched PubMed, Cochrane, EMBASE, and Web of Science for studies published until January 2017 describing the outcomes in patients with STEMI who received red blood cell transfusion, compared with patients who did not.ResultsA total of 21,770 patients with STEMI from 5 cohort studies were included in the meta-analysis, 984 (4.5%) received red blood cell transfusion and 20,786 (95.4%) did not. Red blood cell transfusion was associated with a higher risk of in-hospital and long-term mortality, emergency repeated percutaneous coronary intervention (PCI), reinfarction rate, stroke rate, and heart failure. The group with red blood cell transfusion had a slightly higher incidence of diabetes mellitus and hypertension, but a lower incidence of smoking. The two groups had the same incidence of prior myocardial infarction, prior coronary artery bypass graft surgery and malignancy. Prior heart failure, prior stroke and prior PCI were more frequent in the group that had received red blood cell transfusion. The mean nadir haemoglobin was 8.5 ± 0.1 g/dl in the group with red blood cell transfusion and 12.5 ± 0.4 g/dl in the control group, p < 0.001.ConclusionsRed blood cell transfusion increases the morbidity and mortality in patients with STEMI. This difference could not be explained by the higher morbidity in the red blood cell transfusion group alone. Further randomised controlled trials are required to provide a reliable haemoglobin threshold for these patients.Electronic supplementary materialThe online version of this article (10.1007/s12471-018-1137-x) contains supplementary material, which is available to authorized users.

Temporal Trends in in-Hospital Bleeding and Transfusion in a Contemporary Canadian ST-Elevation Myocardial Infarction Patient Population

“…40 Furthermore, a recent meta-analysis of 5 cohort studies including 21,770 patients confirmed that red blood cell transfusion was associated with in-hospital and long-term mortality, repeat emergency PCI, reinfarction, and heart failure. 41 In our study, transfused patients had worse outcomes after multivariable modelling and almost half of the patients who were transfused without a bleeding event had anemia. The equipoise of transfusion in patients with STEMI is still unclear and the lack of consensus and guidelines result in each centre establishing different thresholds for transfusion in asymptomatic patients.…”

Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients

“…myocardial infarction) with anaemia remain ambiguous: in some studies, RBCT reduced mortality 35,36 while in others RBCT increased adverse outcomes after percutaneous coronary intervention 37 and in ST-elevation myocardial infarction. 38 In anaemic patients with aneurysmal subarachnoid haemorrhage, RBCTs are suggested to be beneficial when there was no considerable anaemia beforehand. 39 On the other hand, in the setting of perioperative procedures RBCT was suggested to be associated with stroke.…”

Assessment of coronary artery disease during hospitalization for cancer treatment

“…Previous studies on patients with cancer and CAD showed that this cohort may be undertreated from the clinical and interventional point of view [ 16 , 17 ]. Low platelet counts, bleeding complications, cancer surgery, percutaneous coronary intervention (PCI), and antiplatelet therapy represent major challenges in the treatment of cancer patients with CAD [ 18 – 20 ]. Decision algorithms for coronary angiography and peri-interventional management pathways for cancer patients are incompletely defined [ 3 , 21 ].…”