CLINICAL RESEARCH: MYOCARDIAL INFARCTION
The Implications of Blood Transfusions for Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
Results From the CRUSADE National Quality Improvement Initiative
Xin Yang, MD, MRCP*,
Karen P. Alexander, MD, FACC*,
Anita Y. Chen, MS*,
Matthew T. Roe, MD, MHS, FACC*,
Ralph G. Brindis, MD, MPH, FACC ,
Sunil V. Rao, MD*,
W. Brian Gibler, MD ,
E. Magnus Ohman, MD, FACC ,
Eric D. Peterson, MD, MPH, FACC*,* for the CRUSADE Investigators
* Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Kaiser-Permanente San Francisco Medical Center, San Francisco, California
University of Cincinnati School of Medicine, Cincinnati, Ohio
Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
Manuscript received April 21, 2005;
revised manuscript received June 21, 2005,
accepted June 27, 2005.
* Reprint requests and correspondence: Dr. Eric D. Peterson, Duke Clinical Research Institute, Box 17969, Durham, North Carolina 27715. (Email: peter016{at}mc.duke.edu).
OBJECTIVES: In a large contemporary population of patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS), we sought to describe blood transfusion rates (overall and in patients who did not undergo coronary artery bypass grafting [CABG]), patient characteristics and practices associated with transfusion, variation among hospitals, and in-hospital outcomes in patients receiving transfusions.
BACKGROUND: The use of antithrombotic agents and invasive procedures reduces ischemic complications but increases risks for bleeding and need for blood transfusion in patients with NSTE ACS.
METHODS: We evaluated patient characteristics and transfusion rates in the overall population (n = 85,111) and determined outcomes and factors associated with need for transfusion in a subpopulation of patients who did not undergo CABG (n = 74,271) from 478 U.S. hospitals between January 1, 2001, and March 31, 2004.
RESULTS: A total of 14.9% of the overall and 10.3% of the non-CABG population underwent transfusion during their hospitalization. Renal insufficiency and advanced age were strongly associated with the likelihood of transfusion. Interhospital transfusion rates varied significantly. Non-CABG patients who received transfusions had a greater risk of death (11.5% vs. 3.8%) and death or reinfarction (13.4% vs. 5.8%) than patients who did not undergo transfusion.
CONCLUSIONS: Transfusion is common in the setting of NSTE ACS, and patients who undergo transfusion are sicker at baseline and experience a higher risk of adverse outcomes than their nontransfused counterparts. Given the wide variation in transfusion practice, further efforts to understand patient and process factors that result in bleeding and need for transfusion in NSTE ACS are needed.
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Abbreviations and Acronyms
| | CABG = coronary artery bypass grafting | | CHF = congestive heart failure | | CRUSADE = Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines | | MI = myocardial infarction | | NSTE ACS = non–ST-segment elevation acute coronary syndromes |
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