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  • Amin AM
  • Ali K
  • Elbenawi H
  • Saber A
  • Abuelazm M
  • et al.
Coron Artery Dis. 2024 May 1;35(3):239-251 doi: 10.1097/MCA.0000000000001349.
POPULATION:

Patients with acute myocardial infarction and anaemia (4 randomised controlled trials, n= 4,325).

INTERVENTION:

Restrictive blood transfusion strategy (n= 2,170).

COMPARISON:

Liberal blood transfusion strategy (n= 2,155).

OUTCOME:

There was no significant difference between both groups regarding major adverse cardiovascular events whether at 30 days (risk ratio (RR) 0.93; 95% CI [0.57, 1.51]) or ≥ six months (RR 1.17; 95% CI [0.95, 1.45]), all-cause mortality at 30 days (RR 1.16; 95% CI [0.95, 1.40]) or ≥ six months (RR 1.16; 95% CI [0.88, 1.53]). The liberal strategy was significantly associated with increased haemoglobin level change (mean difference: -1.44; 95% CI [-1.68, -1.20]). The restrictive strategy was significantly associated with a lower incidence of acute lung injury (RR 0.11; 95% CI [0.02, 0.60].

BACKGROUND:

Blood transfusion strategies in patients with acute myocardial infarction (AMI) and anemia are yet to be conclusively identified. Thus, we aim to assess the efficacy and safety of restrictive versus liberal blood transfusion strategies for AMI and anemia.

METHODS:

A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, web of science, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials were performed through November 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). (PROSPERO): ID: CRD42023490692.

RESULTS:

We included four RCTs with 4.325 patients. There was no significant difference between both groups regarding MACE whether at 30 days (RR: 0.93 with 95% CI [0.57-1.51], P  = 0.76) or ≥ six months (RR: 1.17 with 95% CI [0.95-1.45], P  = 0.14), all-cause mortality at 30 days (RR: 1.16 with 95% CI [0.95-1.40], P  = 0.14) or ≥ six months (RR: 1.16 with 95% CI [0.88-1.53], P  = 0.28). However, the liberal strategy was significantly associated with increased hemoglobin level change (MD: -1.44 with 95% CI [-1.68 to -1.20], P  < 0.00001). However, the restrictive strategy was significantly associated with a lower incidence of acute lung injury (RR: 0.11 with 95% CI [0.02-0.60], P  = 0.01).

CONCLUSION:

There was no significant difference between the restrictive blood transfusion strategy and the liberal blood transfusion strategy regarding the clinical outcomes. However, restrictive blood transfusion strategy was significantly associated with a lower incidence of acute lung injury than liberal blood transfusion strategy.