红细胞输血的模式和结果在接受皮肤冠状动脉干预的患者中
Matthew W Sherwood1, Yongfei Wang2, Jeptha P Curtis2
1Duke Clinical Research Institute, Durham, North Carolina.
JAMA
|February 27, 2014
概括
在接受皮肤冠状动脉干预 (PCI) 的患者中,红细胞输血在美国医院之间有显著的差异. 输血与心脏不良事件的风险更高有关,这表明需要进一步研究最佳输血策略.
科学领域:
- 心脏病学 心脏病学
- 输血医学 输血医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 红细胞输血实践在急性冠状动脉综合征患者之间存在很大差异.
- 在接受皮肤冠状动脉干预 (PCI) 的患者中,对输血的疗效和潜在危害的数据有限.
- 目前PCI患者的输血模式尚不清楚.
研究的目的:
- 为了检查在美国医院接受PCI的患者当前的输血模式.
- 在这个患者群体中调查输血与心脏不良结果之间的关联.
主要方法:
- 使用CathPCI注册表数据进行的回顾性队列研究 (2009年7月 - 2013年3月).
- 包括超过220万名涉及PCI的患者访问,不包括那些缺乏出血数据或接受冠状动脉旁路移植手术的患者.
- 分析了输血率及其与心肌梗塞,中风和死亡的相关性,并根据患者对输血的倾向进行调整.
主要成果:
- 整体输血率为2.14%,在研究期间观察到略有下降.
- 即使在风险调整后,输血率在医院一级的显著变化仍然存在.
- 输血与心肌梗塞 (OR 2.60),中风 (OR 7.72) 和住院死亡 (OR 4.63) 的几率增加有关,而不考虑出血并发症.
结论:
- 在美国,接受PCI的患者的输血实践存在相当大的差异.
- 接受输血与在医院内发生不良心脏事件的风险更高有关.
- 这些发现支持需要随机试验来评估PCI患者的输血策略.
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