Gregory Ducrocq1, Etienne Puymirat2, Philippe Gabriel Steg3, Patrick Henry4, Michel Martelet5, Carma Karam6, François Schiele7, Tabassome Simon8, Nicolas Danchin2. 1. 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. 2. APHP, Hôpital Européen Georges Pompidou, Paris, France. 3. 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. 4. APHP, Hôpital Lariboisière, Paris, France. 5. Centre Hospitalier de Langres, Paris, France. 6. Hôpital Ambroise Paré, Paris, France. 7. CHU Besançon, Besançon, France. 8. APHP, Hôpital Saint Antoine, Paris, France.
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.
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: Gregory Ducrocq; Jose R Gonzalez-Juanatey; Etienne Puymirat; Gilles Lemesle; Marine Cachanado; Isabelle Durand-Zaleski; Joan Albert Arnaiz; Manuel Martínez-Sellés; Johanne Silvain; Albert Ariza-Solé; Emile Ferrari; Gonzalo Calvo; Nicolas Danchin; Cristina Avendaño-Solá; Jerome Frenkiel; Alexandra Rousseau; Eric Vicaut; Tabassome Simon; Philippe Gabriel Steg Journal: JAMA Date: 2021-02-09 Impact factor: 56.272
Authors: Viktoria Kuhn; Lukas Diederich; T C Stevenson Keller; Christian M Kramer; Wiebke Lückstädt; Christina Panknin; Tatsiana Suvorava; Brant E Isakson; Malte Kelm; Miriam M Cortese-Krott Journal: Antioxid Redox Signal Date: 2017-01-18 Impact factor: 8.401