Blood transfusion, bleeding, anemia, and survival in patients with acute myocardial infarction: FAST-MI registry

Ducrocq, Grégory; Puymirat, Étienne; Steg, Philippe Gabriel; Henry, Patrick; Martelet, Michel; Karam, Carma; Schiele, François; Simon, Tabassome; Danchin, Nicolás

doi:10.1016/j.ahj.2015.07.004

Cited by 26 publications

(32 citation statements)

References 21 publications

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“…These results extend and are largely consistent with earlier observations documenting a high prevalence of anemia in both heart failure and ACS 4. Others have also shown excess risk associated with anemia in the setting of ACS 5, 6, 7. These findings, in concert with earlier studies, lead to several natural questions with important clinical impact.…”

Section: Introductionsupporting

confidence: 90%

Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Farhan

Baber

Mehran

2016

JAHA

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Section: Introductionsupporting

confidence: 90%

Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Farhan

Baber

Mehran

2016

JAHA

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“…Anemia is a frequent comorbidity in CVD (48) and is associated with higher mortality as well as increased hospitalization after myocardial infarction (91), even under mild anemic conditions (13, 156). There is accumulating evidence that anemia is related to a series of severe complications in CVD such as thromboembolic events ( e.g ., venous thrombosis and stroke), bleeding complications (191), uncontrolled hypertension (117), more frequent supraventricular and ventricular arrhythmias, and inflammation characterized by elevated levels of inflammatory cytokines (170).…”

Section: Anemia and Cvd: Clinical Aspects And Therapeutic Approachesmentioning

confidence: 99%

“…Increasing evidence exists that anemic patients and patients with coronary artery disease exhibit an elevated risk of major bleeding during hospitalization (48, 132, 174). It was proposed that functional alterations of PLTs (especially aggregability and PLT-endothelial interactions) in anemia (132) or the use of PLT aggregation-inhibiting medication (70) may affect blood flow and viscosity leading to an increased bleeding propensity.…”

Section: Anemia and Cvd: Clinical Aspects And Therapeutic Approachesmentioning

confidence: 99%

“…Despite its simple definition, anemia is characterized by multiple etiologies, phenotype of circulating RBCs, and pathophysiological outcome. Interestingly, there are big cohort/epidemiological studies showing associations between anemia and cardiovascular complications (48, 87, 91). Taking into account the overwhelming body of evidence of novel functional role of RBCs in the cardiovascular system, it is tempting to put forward the hypothesis that anemia may not be a simple bystander in CVD, but may contribute to worsening the outcome.…”

Section: Summary and Open Questionsmentioning

confidence: 99%

“…There is clinical evidence that anemia is also associated with a series of severe complications in cardiovascular disease (CVD) such as thromboembolic events ( e.g ., venous thrombosis and stroke). However, therapeutic interventions aimed to increase the circulating number of RBCs ( e.g ., by transfusion of blood or by administration of erythropoiesis-stimulating agents [ESAs] to stimulate the production of RBCs by the bone marrow), were not always effective in the tested cohorts (48, 91, 156). One possible explanation is that these treatments have side effects and therefore may contribute themselves to the negative outcome, for example, treatment with ESAs was associated with increased thromboembolic events (45).…”

Section: Introductionmentioning

confidence: 99%

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Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia

Kuhn

Diederich

Keller

et al. 2017

Antioxidants & Redox Signaling

313

250

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Significance: Recent clinical evidence identified anemia to be correlated with severe complications of cardiovascular disease (CVD) such as bleeding, thromboembolic events, stroke, hypertension, arrhythmias, and inflammation, particularly in elderly patients. The underlying mechanisms of these complications are largely unidentified.Recent Advances: Previously, red blood cells (RBCs) were considered exclusively as transporters of oxygen and nutrients to the tissues. More recent experimental evidence indicates that RBCs are important interorgan communication systems with additional functions, including participation in control of systemic nitric oxide metabolism, redox regulation, blood rheology, and viscosity. In this article, we aim to revise and discuss the potential impact of these noncanonical functions of RBCs and their dysfunction in the cardiovascular system and in anemia.Critical Issues: The mechanistic links between changes of RBC functional properties and cardiovascular complications related to anemia have not been untangled so far.Future Directions: To allow a better understanding of the complications associated with anemia in CVD, basic and translational science studies should be focused on identifying the role of noncanonical functions of RBCs in the cardiovascular system and on defining intrinsic and/or systemic dysfunction of RBCs in anemia and its relationship to CVD both in animal models and clinical settings. Antioxid. Redox Signal. 26, 718–742.

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Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia

Ducrocq

González-Juanàtey

Puymirat

et al. 2021

JAMA

Self Cite

149

116

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IMPORTANCEThe optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear.OBJECTIVE To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy. DESIGN, SETTING, AND PARTICIPANTSOpen-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL. Enrollment could be considered at any time during the index admission for myocardial infarction. The first participant was enrolled in March 2016 and the last was enrolled in September 2019. The final 30-day follow-up was accrued in November 2019.INTERVENTIONS Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin Յ8; n = 342) or a liberal (transfusion triggered by hemoglobin Յ10 g/dL; n = 324) transfusion strategy. MAIN OUTCOMES AND MEASURESThe primary clinical outcome was major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days. Noninferiority required that the upper bound of the 1-sided 97.5% CI for the relative risk of the primary outcome be less than 1.25. The secondary outcomes included the individual components of the primary outcome. RESULTS Among 668 patients who were randomized, 666 patients (median [interquartile range] age, 77 [69-84] years; 281 [42.2%] women) completed the 30-day follow-up, including 342 in the restrictive transfusion group (122 [35.7%] received transfusion; 342 total units of packed red blood cells transfused) and 324 in the liberal transfusion group (323 [99.7%] received transfusion; 758 total units transfused). At 30 days, MACE occurred in 36 patients (11.0% [95% CI, 7.5%-14.6%]) in the restrictive group and in 45 patients (14.0% [95% CI, 10.0%-17.9%]) in the liberal group (difference, −3.0% [95% CI, −8.4% to 2.4%]). The relative risk of the primary outcome was 0.79 (1-sided 97.5% CI, 0.00-1.19), meeting the prespecified noninferiority criterion. In the restrictive vs liberal group, all-cause death occurred in 5.6% vs 7.7% of patients, recurrent myocardial infarction occurred in 2.1% vs 3.1%, emergency revascularization prompted by ischemia occurred in 1.5% vs 1.9%, and nonfatal ischemic stroke occurred in 0.6% of patients in both groups.CONCLUSIONS AND RELEVANCE Among patients with acute myocardial infarction and anemia, a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of MACE after 30 days. However, the CI included what may be a clinically important harm.

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Blood transfusion, bleeding, anemia, and survival in patients with acute myocardial infarction: FAST-MI registry

Cited by 26 publications

References 21 publications

Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Anemia and Acute Coronary Syndrome: Time for Intervention Studies

Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia

Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia

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