Blood transfusion for PCI associated with increased risk of cardiac event

February 25, 2014

In an analysis that included more than two million patients who underwent a percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), there was considerable variation in red blood cell transfusion practices among hospitals across the U.S., and receiving a transfusion was associated with an increased risk of in-hospital heart attack, stroke or death, according to a study in the February 26 issue of JAMA.

Red blood cell transfusion among patients with coronary artery disease is controversial. A growing body of evidence suggests that transfusion in the setting of (ACS; such as or unstable angina) and in hospitalized patients with a history of coronary artery disease may be associated with an increase in risk of heart attack and death. Current guideline statements are cautious about recommending transfusion in hospitalized patients with a history of and make no recommendation on transfusion in the setting of ACS, citing an absence of definitive evidence, according to background information in the article.

Matthew W. Sherwood, M.D, of Duke Clinical Research Institute, Durham, N.C., and colleagues examined transfusion practice patterns and outcomes in a population representative of patients undergoing PCI across the United States with data from a registry on patient visits (n = 2,258,711) from July 2009 to March 2013 for PCI at 1,431 hospitals.

Overall rate, 2.1 percent of patients undergoing PCI had a transfusion. The researchers found a broad variation in patterns of transfusion across hospitals. Overall, 96.3 percent of sites gave a transfusion to less than 5 percent of patients and 3.7 percent of sites gave a transfusion to 5 percent of patients or more.

Compared to no transfusion, receiving a transfusion was associated with a greater risk of heart attack (4.5 percent vs 1.8 percent), stroke (2.0 percent vs 0.2 percent), and in-hospital death (12.5 percent vs 1.2 percent), irrespective of bleeding complications.

Patients more likely to receive a transfusion were older, were women, and were more likely to have hypertension, diabetes, advanced renal dysfunction, and prior heart attack or heart failure.

The authors speculate that the variation seen in transfusion practice patterns in this study may be related to several factors, including previously held beliefs about the benefit of transfusion and recently published data indicating the lack of benefit and potential hazard associated with transfusion.

"These data highlight the need for randomized trials of transfusion strategies to guide practice in patients undergoing PCI. Until these trials have been completed, operators should use strategies that reduce the risk of bleeding and [need for] ."

Explore further: Transfusion not always best treatment for anemia, age of stored blood may play a role

More information: JAMA DOI: 10.1001/jama.2014.980

Related Stories

AABB releases new guidelines for red blood cell transfusion

March 26, 2012

AABB (formerly known as the American Association of Blood Banks) recommends a restrictive red blood cell transfusion strategy for stable adults and children, according to new guidelines being published in Annals of Internal ...

Restrictive transfusion strategy safe for acute GI bleeding

January 3, 2013

(HealthDay)—For patients with severe acute gastrointestinal bleeding, a restrictive transfusion approach is safe and effective compared with a liberal approach, according to a study published in the Jan. 2 issue of the ...

Recommended for you

Artificial heart design features porous plastic foam

October 2, 2015

Artificial hearts with multiple moving parts increase the chance of failure; scientists have worked up a device which is a single piece. No less interesting is the material they used; the team is taking a page out of soft ...

What powers the pumping heart?

September 25, 2015

Researchers at the Ted Rogers Centre for Heart Research have uncovered a treasure trove of proteins, which hold answers about how our heart pumps—a phenomenon known as contractility.

Sticky gel helps stem cells heal rat hearts

September 24, 2015

A sticky, protein-rich gel created by Johns Hopkins researchers appears to help stem cells stay on or in rat hearts and restore their metabolism after transplantation, improving cardiac function after simulated heart attacks, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.