Prognostic impact of blood transfusion after primary angioplasty for acute myocardial infarction: analysis from the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) Trial

JACC Cardiovasc Interv. 2009 Jul;2(7):624-32. doi: 10.1016/j.jcin.2009.05.004.

Abstract

Objectives: We sought to determine the relationship between red blood cell (RBC) transfusion and clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).

Background: The implications of RBC transfusion in patients undergoing primary PCI for AMI have not been evaluated.

Methods: Clinical outcomes of patients from the prospective, randomized CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial were analyzed by administration of in-hospital RBC transfusion not related to coronary artery bypass surgery.

Results: Of 2,060 randomized patients, 82 (3.98%) received RBC transfusion during the index hospitalization, including 33 (1.60%) with moderate/severe bleeding and 49 (2.38%) without overt major bleeding. Transfusion was independently associated with baseline anemia (odds ratio [95% confidence interval]: 4.44 [2.60 to 7.58], p < 0.0001), older age (1.03 [1.01 to 1.06], p = 0.002), triple-vessel disease (2.54 [1.47 to 4.38], p = 0.0008), and female sex (1.04 [1.02 to 1.06], p = 0.0008). Patients transfused versus not transfused had significantly higher rates of 1-year mortality (23.9% vs. 3.4%), disabling stroke (2.5% vs. 0.5%), reinfarction (7.0% vs. 2.2%), and composite major adverse cardiac events (41.0% vs. 16.6%) (all p values < 0.01). After multivariable adjustment for potential confounders including transfusion propensity, RBC transfusion was independently associated with mortality at 30 days (hazards ratio: 4.71, p = 0.0005) and 1 year (hazards ratio: 3.16, p = 0.0005).

Conclusions: An RBC transfusion after primary PCI in AMI may be harmful, which is consistent with the findings from other studies after PCI in the noninfarct setting. Alternatively, RBC transfusion may be a marker of markedly increased risk. Randomized studies are warranted to determine the optimal threshold for RBC transfusion in patients with AMI undergoing mechanical reperfusion therapy.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Abciximab
  • Age Factors
  • Aged
  • Anemia / complications
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Angioplasty, Balloon, Coronary / instrumentation
  • Angioplasty, Balloon, Coronary / mortality
  • Antibodies, Monoclonal / therapeutic use*
  • Erythrocyte Transfusion / adverse effects*
  • Erythrocyte Transfusion / mortality
  • Female
  • Heart Diseases / etiology
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Odds Ratio
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Proportional Hazards Models
  • Prospective Studies
  • Radiography
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Abciximab