The controversial practice of blood transfusions for patients suffering from cardiac episodes may lead to an increased risk of mortality, and may be correlated to transfusion blood type and blood age, according to research presented at the American College of Cardiology Annual Scientific Session.
The Deleterious Impact of Blood Transfusions on Mortality in Patients with ST-Elevation Myocardial Infarction (Abstract 973-234)
Although opinion on blood transfusions as post-heart attack treatment is divisive, it is common practice for patients who have recently suffered from myocardial infarction, or heart attacks. Study authors from the Cleveland Clinic Foundation in Ohio researched the death rate of heart attack patients who received blood transfusions and found that these transfusions are associated with a markedly increased risk of mortality.
Researchers examined the death rate of 4,073 patients with ST-elevated myocardial infarction 30 days after the heart attack occurred. Among the 363 patients who received transfusions, the post-heart attack death rate after 30 days was 13 percent, compared to just five percent for the 3,710 non-transfused patients. After adjusting for baseline characteristics, transfusion was still associated with higher mortality.
Data showed that the patients who received transfusions were older, more likely to be female, and more likely to suffer from peripheral vascular disease. In addition, they were also more likely to have a history of diabetes and smoking.
"The research suggests that blood transfusions might be associated with increased mortality, but substantial caution should be applied. Blood transfusions are either harmful to patients or they are merely a marker for patients with a more serious medical condition," said Vivek Rajagopal, M.D., Cleveland Clinic Foundation and lead author of the study. "In either case, more research is necessary to determine the appropriate role of blood transfusions in the management of these patients."
Blood Transfusion in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Analysis from the CADILLAC Trial (Abstract 996-241)
The practice of blood transfusions for patients undergoing percutaneous coronary intervention (PCI) is contentious and associated with an increased risk of mortality. However, little is known about the effects of transfusions on patients with acute myocardial infarction (AMI) undergoing primary PCI. Scientists from the Columbia University Medical Center in New York evaluated the outcomes of blood transfusions on these patients and found that those receiving transfusions experienced a notably increased risk of early and late mortality and stroke.
Of the 2,060 patients studied, 82 received a blood transfusion that was not related to coronary bypass grafting. Results found that patients who underwent blood transfusions had strikingly higher rates of deaths and stroke in-hospital, as well as at 30 days and one year post heart attack. Patients experienced a greater than 20 percent chance of death after one year, and an approximately 10 percent greater chance of death in-hospital or after 30 days. These patients were also more likely to be older, female and have a higher prevalence of prior gastrointestinal bleeding, chronic renal insufficiency, lower body mass index, larger infarcts size and lower rates of procedural success.
"Given the outcomes of the CADILLAC trial, the judicious administration of blood transfusions is warranted in patients treated with primary PCI for acute myocardial infarction," said Eugenia Nikolsky, M.D., Ph.D., Columbia University Medical Center and lead author of the study. "More research must be conducted to evaluate the safety and efficacy of blood transfusions in these patients to ensure they have the best chance of recovery possible." Blood Type and the Age of the Red Cells Transfused Affects Mortality After Percutaneous Coronary Intervention (Abstract 997-245)