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European Heart Journal Advance Access published online on July 11, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp279
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Transfusion and mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

E. Marc Jolicœur1, William W. O'Neill2, Anne Hellkamp1, Christian W. Hamm3, David R. Holmes, Jr.4, Hussein R. Al-Khalidi5, Manesh R. Patel1, Frans J. Van de Werf6, Karen Pieper1, Paul W. Armstrong7, Christopher B. Granger1,* and for the APEX-AMI Investigators

1 Duke Clinical Research Institute, Box 3409, Durham, NC 27710, USA
2 University of Miami, Miami, FL, USA
3 Kerckhoff Heart Centre, Bad Nauheim, Germany
4 Mayo Clinic, Rochester, MN, USA
5 Procter & Gamble Pharmaceuticals, Cincinnati, OH, USA
6 University Hospital Gathuisberg, Leuven, Belgium
7 University of Alberta, Edmonton, Alberta, Canada

Received 29 September 2008; revised 19 April 2009; accepted 11 June 2009 * Corresponding author. Tel: +1 919 668 8900, Fax: +1 919 668 7056, Email: grang001{at}mc.duke.edu

Aims: Red blood cell transfusion is associated with increased mortality among patients with acute coronary syndromes, but little is known about the consequences of transfusion in a contemporary setting of ST-segment elevation myocardial infarction. We describe the association between transfusion and 90-day mortality among patients with acute myocardial infarction treated with primary percutaneous coronary intervention.

Methods and results: Analyses were performed on 5532 patients with ST-elevation myocardial infarction from the Assessment of Pexelizumab in Acute Myocardial Infarction trial. The primary objective of this analysis was to ascertain the relation between red blood cell transfusion and 90-day mortality in patients with recent myocardial infarction. We initially determined the baseline and in-hospital predictors of transfusion (multivariable logistic regressions) and subsequently assessed the association between transfusion and mortality using a series of Cox proportional hazards regression combined to a landmark analyses. A total of 213 patients (3.9%) received a transfusion. Transfusion remained significantly associated with mortality [hazards ratio = 2.16 (1.20–3.88)], despite adjustment for baseline characteristics, in-hospital co-interventions, and for propensity of receiving a transfusion. Among patients who survived to hospital discharge, however, the hazard of death was not different in patients treated with transfusion.

Conclusion: Transfusion is associated with 90-day mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. Although transfusion may be causally related to mortality, it is likely that at least part of the association is due to confounding. This association illustrates the complex relationship between transfusion, bleeding, and mortality and underscores the need for further research to understand the relationship between transfusion and clinical outcomes.

Key Words: Red blood cell transfusion • Bleeding • Acute myocardial infarction • Primary percutaneous coronary intervention


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