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Published on: February 2, 2021
Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing
Wassef Karrowni1, Amit Navin Vora2, David Dai2
1From the Unity Point Clinic-St. Luke's Hospital, Cedar Rapids, IA (W.K.); Duke Clinical Research Institution, Durham, NC (A.N.V., D.D., D.W., S.V.R.); and American University of Beirut, Lebanon (H.D.). wassef@hotmail.com.
Insights
Blood transfusion significantly increases the risk of acute kidney injury (AKI) following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. Further research is needed to explore restrictive transfusion strategies.
Area of Science:
- Cardiology
- Nephrology
- Transfusion Medicine
Background:
- Acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is linked to poor patient outcomes.
- The relationship between blood transfusions and AKI in PCI patients has not been previously studied.
Purpose of the Study:
- To investigate the association between blood transfusion and the incidence of AKI in patients undergoing PCI for acute coronary syndrome.
- To evaluate the impact of blood transfusion on AKI risk, regardless of bleeding events.
Main Methods:
- Retrospective cohort study utilizing the CathPCI Registry.
- Inclusion of 1,756,864 patients with acute coronary syndrome undergoing PCI.
- AKI defined as a post-procedure serum creatinine increase of ≥0.5 mg/dL or ≥25%.
Main Results:
- AKI occurred in 9.0% of the study population.
- Patients receiving blood transfusions had a significantly higher incidence of AKI (35.1% vs. 8.4%).
- An adjusted odds ratio of 4.87 indicated a strong association between transfusion and AKI, even in patients without bleeding events.
Conclusions:
- Blood transfusion is strongly associated with AKI in acute coronary syndrome patients undergoing PCI.
- Investigating restrictive blood transfusion strategies may be crucial for improving PCI outcomes by mitigating AKI risk.
Background:
Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI.
Methods And Results:
We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin levels versus no blood transfusion. Similar findings were seen in the subgroup of patients with no bleeding event.
Conclusions:
Blood transfusion is strongly associated with AKI in patients with acute coronary syndrome undergoing PCI. Further investigation is needed to determine whether a restrictive blood transfusion strategy might improve PCI outcomes by reducing the risk of AKI.
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