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Impact of Blood Transfusion on Short- and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction

Mehdi H. Shishehbor, DO, MPH^_*,_*, Surabhi Madhwal, MD, Vivek Rajagopal, MD, Amy Hsu, MS, Peter Kelly, MD^_*, Hitinder S. Gurm, MD^||, Samir R. Kapadia, MD^_*, Michael S. Lauer, MD^¶, Eric J. Topol, MD^#

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
^|| Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
^¶ Division of Prevention and Population Science, National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, Maryland
^# Division of Cardiovascular Diseases, Scripps Clinic and The Scripps Research Institute, La Jolla, California

^_* Reprint requests and correspondence: Dr. Mehdi H. Shishehbor, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, JJ40, Cleveland, Ohio 44195 (Email: shishem{at}gmail.com).

Objectives: We sought to examine the short- and long-term outcomes of blood transfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI).

Background: The short- and long-term consequences of blood transfusion in anemic patients with recent STEMI remain controversial.

Methods: We evaluated 30-day, 6-month, and 1-year all-cause mortality among 4,131 STEMI patients enrolled in the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb trial. Patients were categorized according to whether they received a blood transfusion during hospitalization. Cox proportional hazards survival models with transfusion as a time-dependent covariate were conducted for the whole and for the propensity-matched groups. Additionally, a series of sensitivity analyses assessed the magnitude of hidden bias that would need to be present to explain the associations actually observed.

Results: Death at 30 days (13.7% vs. 5.5%), 6 months (19.7% vs. 6.9%), and 1 year (21.8% vs. 8.7%) was significantly higher for transfused patients than for nontransfused patients, respectively. After adjusting for over 25 baseline characteristics, nadir hemoglobin, and propensity score for transfusion, and using transfusion as a time-dependent covariate, transfusion remained significantly associated with increased risk of mortality at 30 days (hazard ratio [HR]: 3.89, 95% confidence interval [CI]: 2.66 to 5.68, p < 0.001), 6 months (HR: 3.63, 95% CI: 2.67 to 4.95, p < 0.001), and 1 year (HR: 3.03, 95% CI: 2.25 to 4.08, p < 0.001). Similar results were observed in the propensity-matched patients.

Conclusions: Blood transfusion is associated with increased short- and long-term mortality in the setting of STEMI.

Key Words: blood transfusion • ST-segment elevation myocardial infarction • long-term outcome • propensity analysis

Abbreviations and Acronyms   ACS = acute coronary syndromes   STEMI = ST-segment elevation myocardial infarction

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