Blood transfusion and ischaemic outcomes according to anemia and bleeding in patients with non-ST-segment elevation acute coronary syndromes: Insights from the TAO randomized clinical trial

Departement de Cardiologie, CHU Timone, Marseille F-13385, France; Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France; Aix-Marseille Universite, Faculte de Medecine, F-13385 Marseille, France. Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris, France; Universite Paris-Diderot, Departement Hospitalo-Universitaire FIRE, Sorbonne-Paris Cite, Paris, France; FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network,l: NHLI, Royal Brompton Hospital, Imperial College, London, United Kingdom. Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany. Newark Beth Israel Medical Center, Rutgers-New Jersey Medical School, Newark, New Jersey, USA. Departement de Cardiologie, CHU Timone, Marseille F-13385, France. McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Department of Cardiology, Duke Clinical Research Institute, Durham, NC, USA. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Pilsonu Street 13, Riga, Latvia. Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, 6900 Lugano, Switzerland. Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris, France; Universite Paris-Diderot, Departement Hospitalo-Universitaire FIRE, Sorbonne-Paris Cite, Paris, France; FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network,l: NHLI, Royal Brompton Hospital, Imperial College, London, United Kingdom. Electronic address: gabriel.steg@aphp.fr

Int J Cardiol. 2020
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Abstract
BACKGROUND The benefits and risks of blood transfusion in patients with acute myocardial infarction who are anemic or who experience bleeding are debated. We sought to study the association between blood transfusion and ischemic outcomes according to haemoglobin nadir and bleeding status in patients with NST-elevation myocardial infarction (NSTEMI). METHODS The TAO trial randomized patients with NSTEMI and coronary angiogram scheduled within 72h to heparin plus eptifibatide versus otamixaban. After exclusion of patients who underwent coronary artery bypass surgery, patients were categorized according to transfusion status considering transfusion as a time-varying covariate. The primary ischemic outcome was the composite of all-cause death or MI within 180 days of randomization. Subgroup analyses were performed according to pre-transfusion hemoglobin nadir and bleeding status. RESULTS 12,547 patients were enrolled. Among these, blood transfusion was used in 489 (3.9%) patients. Patients who received transfusion had a higher rate of death or MI (29.9% vs. 8.1%, p<0.01). This excess risk persisted after adjustment on GRACE score and nadir of hemoglobin (HR 3.36 95%CI 2.63-4.29 p<0.01). Subgroup analyses showed that blood transfusion was associated with a higher risk in patients without overt bleeding (adjusted HR 6.25 vs. 2.85; p-interaction 0.001) as well as in those with hemoglobin nadir > 9.0 g/dl (HR 4.01; p-interaction<0.0001). CONCLUSION In patients with NSTEMI, blood transfusion was associated with an overall increased risk of ischaemic events. However, this was mainly driven by patients without overt bleeding and those hemoglobin nadir > 9.0g/dl. This suggests possible harm of transfusion in those groups.
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Language : eng
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