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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

Eugenia Nikolsky, MD, PhD^_*, Roxana Mehran, MD^_*, H. Mehrdad Sadeghi, MD, Cindy L. Grines, MD, David A. Cox, MD, Eulogio Garcia, MD^||, James E. Tcheng, MD^¶, John J. Griffin, MD^#, Giulio Guagliumi, MD^_**, Thomas Stuckey, MD, Mark Turco, MD, Martin Fahy, MSc^_*, Alexandra J. Lansky, MD^_*, Gregg W. Stone, MD^_*,_*

^_* Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
Sharp Chula Vista Medical Center, Chula Vista, California
William Beaumont Hospital, Royal Oak, Michigan
Mid Carolina Cardiology, Charlotte, North Carolina
^|| Hospital Gregorio Maranon, Madrid, Spain
^¶ Duke Clinical Research Institute, Durham, North Carolina
^# Virginia Beach General Hospital, Virginia Beach, Virginia
^_** Ospedali Riuniti di Bergamo, Bergamo, Italy
Moses Cone Memorial Hospital, Greensboro, North Carolina
Washington Adventist Hospital, Tacoma Park, Maryland

^_* Reprint requests and correspondence: Dr. Gregg W. Stone, Columbia University Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, New York 10032 (Email: gs2184{at}columbia.edu).

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.

Key Words: transfusion • primary angioplasty • myocardial infarction • bleeding

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CAD = coronary artery disease   MI = myocardial infarction   PCI = percutaneous coronary intervention   RBC = red blood cell   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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