Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey
Résumé
BACKGROUND: Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged >= 65 years, according to their age and hemoglobin nadir.
METHODS: We included 3316 consecutive patients with acute myocardial infarction aged >= 65 years from the "obseRvatoire des Infarctus de Cote d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (<= 8, > 8 to <= 10, and > 10 g/dL) and age (<80 or >= 80 years).
RESULTS: A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged >= 80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir > 10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was <= 8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (>= 80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016).
CONCLUSION: Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was > 10 g/dL. However, in patients aged >= 80 years with hemoglobin nadir < 8 g/ dL, transfusion was associated with a 50% reduction in 1-year mortality.