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Blood Transfusions Appear to Harm Patients in Heart Procedures: Presented at ACC
By Ed Susman
ATLANTA, G.A. -- March 15, 2006 -- Blood transfusions, aside from being a marker that a patient is having serious problems, may in themselves be risk factors for poor outcomes in patients being treated for heart attacks or undergoing cardiac interventions.
"The research suggests that blood transfusions might be associated with increased mortality, but substantial caution should be applied," said Vivek Rajagopal, MD, cardiology fellow, Cleveland Clinic Foundation, Cleveland, Ohio. "Blood transfusions are either harmful to patients or they are merely a marker for patients with a more serious medical condition."
Dr. Rajagopal presented his findings on March 14th at the 55th Annual Scientific Session of the American College of Cardiology (ACC).
In his multivariate analysis, Dr. Rajagopal compared 363 transfused patients with 3710 nontransfused patients. The study data show that the most robust risk factor for death in the transfusion group was the fact that they received transfusion, which increased their risk of dying by 3.6 times. About 13% of the transfused group died within 30 days of a heart attack compared with 5% of the patients who did not require a transfusion. That difference, he said was statistically significant at the P <.0001 level.
In another study presented on March 14th at the ACC meeting, Evgenia Nikolsky, MD, instructor in clinical medicine-cardiology, Columbia University Medical Center, New York, New York, scrutinized records of patients in the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC).
The trial enrolled patients undergoing primary percutaneous coronary interventions and found that 82 out of 2060 patients required blood transfusions.
Results of this study show that subjects getting the transfusions had a 10% greater risk of dying of stroke or heart attack in hospital and a 20% risk of dying during the year after the procedure.
"Given these outcomes, the judicious administration of blood transfusions is warranted in patients treated with primary percutaneous coronary interventions," Dr. Nikolsky said.
Peter Kim, MD, clinical cardiology fellow, William Beaumont Hospital, Detroit, Michigan, analyzed what effect the age of stored blood has on patients receiving blood transfusions. He also presented his findings at the ACC meeting.
In Dr. Kim's study, patients received blood stored longer than 25 days. He found that patients receiving blood types A or AB were less likely to survive to 5 years after undergoing percutaneous coronary interventions.
Older blood might cause more inflammatory reactions in the host after transfusion, Dr. Kim said. Because types A and AB blood are rare, these stored blood units tend to be older.
[Presentation title: The Deleterious Impact of Blood Transfusions on Mortality in Patients With ST-Elevation Myocardial Infarction. Abstract 973-234. Blood Transfusions in Patients Undergoing Primary Percutaneous Coronary Interventions for Acute Myocardial Infarction: Analysis From the CADILLAC Trial. Abstract 996-241. Blood Type and the Age of The Red Cells Transfused Affects Mortality After Percutaneous Coronary Interventions. Abstract 997-245]
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