Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia
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
- Fonction : co premier-auteur
- PersonId : 1545751
- ORCID : 0000-0001-5466-2833
- Fonction : Auteur
- Fonction : Auteur
- PersonId : 741176
- IdHAL : tabassome-simon
- ORCID : 0000-0002-4550-0450
- IdRef : 070443122
- Fonction : Auteur
- PersonId : 1545752
- ORCID : 0000-0003-0310-0616
- Fonction : Auteur
- PersonId : 1230660
- ORCID : 0000-0003-4069-1128
- Fonction : Auteur
- PersonId : 1545753
- ORCID : 0000-0002-6592-6141
- Fonction : Auteur
- PersonId : 1230661
- ORCID : 0000-0002-8233-6039
- Fonction : Auteur
- PersonId : 1222900
- ORCID : 0000-0002-1901-2808
- IdRef : 110783166
- Fonction : Auteur
- PersonId : 770451
- ORCID : 0000-0002-0533-9682
- Fonction : Auteur
- PersonId : 1275860
- ORCID : 0000-0001-6922-0093
- IdRef : 144709031
- Fonction : Auteur
- PersonId : 781321
- ORCID : 0000-0001-6167-500X
- IdRef : 177252502
- Fonction : Auteur
- PersonId : 1043013
- ORCID : 0000-0001-6896-2941
- IdRef : 035585978
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.