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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Red blood cell transfusion in patients with ST-elevation myocardial infarction-a meta-analysis of more than 21,000
Insights
Red blood cell transfusion in ST-elevation myocardial infarction (STEMI) patients is linked to increased mortality and complications. Further research is needed to establish safe hemoglobin thresholds for transfusion in these critical cases.
Area of Science:
- Cardiology
- Transfusion Medicine
- Clinical Research
Background:
- Red blood cell transfusion is a debated intervention in acute coronary syndromes, especially ST-elevation myocardial infarction (STEMI).
- Existing evidence on transfusion outcomes in STEMI patients is limited and warrants further investigation.
Purpose of the Study:
- To evaluate the association between red blood cell transfusion and clinical outcomes in patients with STEMI.
- To compare the risks and complications in STEMI patients who received red blood cell transfusion versus those who did not.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Cochrane, EMBASE, Web of Science) up to January 2017.
- A meta-analysis included data from 5 cohort studies, encompassing 21,770 patients with STEMI.
Main Results:
- Red blood cell transfusion (4.5% of patients) was associated with higher in-hospital and long-term mortality.
- Transfused STEMI patients faced increased risks of repeated percutaneous coronary intervention, reinfarction, stroke, and heart failure.
- The transfusion group had lower hemoglobin levels and higher rates of pre-existing conditions like diabetes, hypertension, prior heart failure, and stroke.
Conclusions:
- Red blood cell transfusion significantly increases morbidity and mortality in STEMI patients.
- The observed adverse effects extend beyond pre-existing comorbidities in the transfused group.
- Randomized controlled trials are essential to determine optimal hemoglobin thresholds for transfusion in STEMI management.
Background:
Red blood cell transfusion remains controversial in patients with acute coronary syndromes and particularly in patients with ST-elevation myocardial infarction (STEMI).
Methods:
We 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.
Results:
A 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.
Conclusions:
Red 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.
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