Restrictive vs Liberal Blood Transfusions for Patients with Acute Myocardial Infarction and Anaemia by Heart Failure Status : An RCT Subgroup Analysis
Copyright © 2024. Published by Elsevier Inc..
BACKGROUND: Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI).
METHODS: We used data from the randomized REALITY trial (https://www.
CLINICALTRIALS: gov/study/NCT02648113), comparing restrictive versus liberal transfusion strategies in patients with AMI and anaemia. HF was defined as history of HF or Killip class > 1 at randomization. Primary outcome was major adverse cardiovascular events (MACE: composite of all-cause death, non-recurrent AMI, stroke, or emergency revascularization prompted by ischaemia) at 30 days.
RESULTS: Among 658 randomized patients, 311 (47.3%) had HF. HF patients had higher rates of MACE at 30 days and 1 year, and higher rates of non-fatal new-onset HF. There was no interaction between HF and effect of randomized assignment on the primary outcome or non-fatal new-onset HF. A liberal transfusion strategy was associated with increased all-cause death at 30 days and at 1 year in HF patients (Pinteraction = 0.009 and P = 0.049, respectively). The main numerical difference in cause of death between restrictive and liberal strategies was death by HF at 30 days (4 vs 11).
CONCLUSIONS: HF is frequent in AMI patients with anaemia and is associated with higher risk of MACE (including all-cause death) and non-fatal new-onset HF. While there was no interaction of HF with effect of transfusion strategy on MACE, a liberal transfusion strategy was associated with higher all-cause death that appears driven by a higher risk of early death due to HF.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
The Canadian journal of cardiology - (2024) vom: 24. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ducrocq, Gregory [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 26.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.cjca.2024.02.013 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368986640 |
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| 100 | 1 | |a Ducrocq, Gregory |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Restrictive vs Liberal Blood Transfusions for Patients with Acute Myocardial Infarction and Anaemia by Heart Failure Status |b An RCT Subgroup Analysis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Revised 26.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024. Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: Red blood cell transfusion can cause fluid overload. We evaluated the interaction between heart failure (HF) at baseline and transfusion strategy on outcomes in acute myocardial infarction (AMI) | ||
| 520 | |a METHODS: We used data from the randomized REALITY trial (https://www | ||
| 520 | |a CLINICALTRIALS: gov/study/NCT02648113), comparing restrictive versus liberal transfusion strategies in patients with AMI and anaemia. HF was defined as history of HF or Killip class > 1 at randomization. Primary outcome was major adverse cardiovascular events (MACE: composite of all-cause death, non-recurrent AMI, stroke, or emergency revascularization prompted by ischaemia) at 30 days | ||
| 520 | |a RESULTS: Among 658 randomized patients, 311 (47.3%) had HF. HF patients had higher rates of MACE at 30 days and 1 year, and higher rates of non-fatal new-onset HF. There was no interaction between HF and effect of randomized assignment on the primary outcome or non-fatal new-onset HF. A liberal transfusion strategy was associated with increased all-cause death at 30 days and at 1 year in HF patients (Pinteraction = 0.009 and P = 0.049, respectively). The main numerical difference in cause of death between restrictive and liberal strategies was death by HF at 30 days (4 vs 11) | ||
| 520 | |a CONCLUSIONS: HF is frequent in AMI patients with anaemia and is associated with higher risk of MACE (including all-cause death) and non-fatal new-onset HF. While there was no interaction of HF with effect of transfusion strategy on MACE, a liberal transfusion strategy was associated with higher all-cause death that appears driven by a higher risk of early death due to HF | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Cachanado, Marine |e verfasserin |4 aut | |
| 700 | 1 | |a Simon, Tabassome |e verfasserin |4 aut | |
| 700 | 1 | |a Puymirat, Etienne |e verfasserin |4 aut | |
| 700 | 1 | |a Lemesle, Gilles |e verfasserin |4 aut | |
| 700 | 1 | |a Lattuca, Benoit |e verfasserin |4 aut | |
| 700 | 1 | |a Ariza-Solé, Albert |e verfasserin |4 aut | |
| 700 | 1 | |a Silvain, Johanne |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Emile |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez-Juanatey, Jose R |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez-Sellés, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Lermusier, Thibault |e verfasserin |4 aut | |
| 700 | 1 | |a Coste, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Vanzetto, Gerald |e verfasserin |4 aut | |
| 700 | 1 | |a Cottin, Yves |e verfasserin |4 aut | |
| 700 | 1 | |a Dillinger, Jean G |e verfasserin |4 aut | |
| 700 | 1 | |a Calvo, Gonzalo |e verfasserin |4 aut | |
| 700 | 1 | |a Steg, Philippe Gabriel |e verfasserin |4 aut | |
| 700 | 0 | |a REALITY Investigators |e verfasserin |4 aut | |
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