Article Dans Une Revue New England Journal of Medicine Année : 2023

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

1 RU - Rutgers, The State University of New Jersey [New Brunswick]
2 PITT - University of Pittsburgh
3 Bruyère Research Institute
4 CR CHUM - Centre de Recherche du Centre Hospitalier de l’Université de Montréal
5 St. Michael's Hospital
6 University of Toronto
7 University of Alberta
8 NHLBI - National Heart, Lung, and Blood Institute [Bethesda]
9 SLU - Saint Louis University
10 PASS-CRB-APHP-SU - Centre de Ressources Biologiques APHP-SU
11 FACT - Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials
12 CHU Saint-Antoine [AP-HP]
13 Duke Clinical Research Institute
14 Duke University [Durham]
15 University of Nebraska Medical Center
16 Vanderbilt University Medical Center [Nashville]
17 Warren Alpert Medical School of Brown University
18 Duke University Medical Center
19 NYU Langone Health [New York]
20 WMC - Westchester Medical Center [Valhalla, New York, USA]
21 University of Louisville School of Medicine [Louisville]
22 OHRI - Ottawa Hospital Research Institute [Ottawa]
23 The University of Chicago Medicine [Chicago]
24 Service de Chirurgie Thoracique et Vasculaire [Hôpital Bichat]
25 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
26 BCRI - Brazilian Clinical Research Institute [São Paulo, Brazil]
27 GLCC - Green Lane Coordinating Center [Auckland, New Zealand]
28 Montefiore Medical Center [Bronx, New York]
29 McMaster University [Hamilton, Ontario]
30 BIDMC - Beth Israel Deaconess Medical Center [Boston]
31 VGH - Vancouver General Hospital [Vancouver, British Columbia, Canada]
32 UBC - University of British Columbia [Canada]
33 CHU - Hôpital Pasteur [Nice]
34 CHU Nice - Centre Hospitalier Universitaire de Nice
35 Groupe Action
36 WakeMed - WakeMed Health and Hospitals [North Carolina, USA]
37 UdeS - Université de Sherbrooke = University of Sherbrooke [Sherbrooke]
38 Grey Nuns Community Hospital [Edmonton, Alberta, Canada]
39 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
40 Service de cardiologie [CHU HEGP]
41 CIC 1402 - CIC de Poitiers – Centre d'investigation clinique de Poitiers (CIC 1402)
42 Service de cardiologie [CHU de Poitiers]
43 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
44 UM - Université de Montpellier
Johanne Silvain

Résumé

BACKGROUND: A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.
METHODS: In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.
RESULTS: A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).
CONCLUSIONS: In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded.

Dates et versions

hal-05086219 , version 1 (27-05-2025)

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Citer

Jeffrey Carson, Maria Mori Brooks, Paul C. Hébert, Shaun G. Goodman, Marnie Bertolet, et al.. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. New England Journal of Medicine, 2023, 389 (26), pp.2446-2456. ⟨10.1056/NEJMoa2307983⟩. ⟨hal-05086219⟩
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