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Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey
Alain Putot1, Marianne Zeller2, Sophie Perrin1
1Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France.
Insights
Red blood cell transfusion in elderly patients with acute myocardial infarction (AMI) shows varied outcomes. For those aged 80+, a hemoglobin nadir below 8 g/dL indicates transfusion may reduce mortality.
Area of Science:
- Cardiology
- Geriatrics
- Transfusion Medicine
Background:
- The benefit of red blood cell transfusion in elderly patients experiencing acute myocardial infarction (AMI) is not well-established.
- This study investigates the impact of transfusion on 1-year mortality in older AMI patients.
Purpose of the Study:
- To assess the effect of red blood cell transfusion on 1-year mortality in patients aged 65 years and older with AMI.
- To analyze this effect based on patient age (categorized as <80 and ≥80 years) and hemoglobin nadir levels.
Main Methods:
- Utilized data from 3316 consecutive AMI patients aged ≥65 years from the RICO survey.
- Patients were stratified by hemoglobin nadir (≤8, >8 to ≤10, >10 g/dL) and age (<80 or ≥80 years).
- Cox regression analysis was employed to evaluate the association between transfusion and 1-year mortality.
Main Results:
- Transfusion was linked to increased 1-year mortality in patients with a hemoglobin nadir >10 g/dL.
- No significant effect on mortality was observed for hemoglobin nadir between 8-10 g/dL.
- In patients ≥80 years with a hemoglobin nadir ≤8 g/dL, transfusion was associated with a 50% reduction in 1-year mortality (HR 0.43; 95% CI, 0.22-0.86).
Conclusions:
- The impact of red blood cell transfusion in older AMI patients is contingent on both age and hemoglobin threshold.
- Transfusion may increase mortality when hemoglobin nadir exceeds 10 g/dL.
- For very elderly patients (≥80 years) with a low hemoglobin nadir (≤8 g/dL), transfusion appears to be associated with reduced 1-year mortality.
Background:
Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir.
Methods:
We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8, >8 to ≤10, and >10 g/dL) and age (<80 or ≥80 years).
Results:
A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir >10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was ≤8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (≥80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016).
Conclusion:
Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was >10 g/dL. However, in patients aged ≥80 years with hemoglobin nadir <8 g/dL, transfusion was associated with a 50% reduction in 1-year mortality.