Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

被引：50

作者：

Carson, J. L. ^{[1
]}

Brooks, M. M. ^{[2
,3
]}

Hebert, P. C. ^{[5
,11
,12
]}

Goodman, S. G. ^{[7
,8
]}

Bertolet, M. ^{[2
,3
]}

Glynn, S. A. ^{[19
]}

Chaitman, B. R. ^{[20
]}

Simon, T. ^{[21
,22
]}

Lopes, R. D. ^{[30
,32
]}

Goldsweig, A. M. ^{[33
,36
]}

Defilippis, A. P. ^{[37
]}

Abbott, J. D. ^{[38
,39
]}

Potter, B. J. ^{[10
]}

Carrier, F. M. ^{[11
,12
,13
]}

Rao, S. V. ^{[40
]}

Cooper, H. A. ^{[42
]}

Ghafghazi, S. ^{[43
]}

Fergusson, D. A. ^{[6
]}

Kostis, W. J. ^{[1
]}

Noveck, H. ^{[1
]}

Kim, S. ^{[1
]}

Tessalee, M. ^{[44
]}

Ducrocq, G. ^{[21
,23
,24
]}

Silva, P.

Triulzi, D. J. ^{[4
]}

Alsweiler, C. ^{[46
]}

Menegus, M. A. ^{[41
]}

Neary, J. D. ^{[14
]}

Uhl, L. ^{[34
]}

Strom, J. B. ^{[35
]}

Fordyce, C. B. ^{[15
,16
,17
,28
]}

Ferrari, E. ^{[27
]}

Silvain, J. ^{[25
]}

Wood, F. O. ^{[31
]}

Daneault, B. ^{[18
]}

Polonsky, T. S. ^{[45
]}

Senaratne, M. ^{[9
]}

Puymirat, E. ^{[26
]}

Bouleti, C.

Lattuca, B. ^{[29
]}

White, H. D. ^{[46
]}

Kelsey, S. F. ^{[2
,3
]}

Steg, P. G. ^{[21
,23
,24
,32
]}

Alexander, J. H. ^{[30
]}

机构：

[1] Rutgers Robert Wood Johnson Med Sch, Dept Med, Clin Acad Bldg,125 Paterson St, New Brunswick, NJ 08901 USA

[2] Univ Pittsburgh, Dept Epidemiol, Sch Publ Hlth, Pittsburgh, PA USA

[3] Univ Pittsburgh, Sch Publ Hlth, Dept Biostat, Pittsburgh, PA USA

[4] Univ Pittsburgh, Sch Med, Dept Pathol, Div Transfus Med, Pittsburgh, PA USA

[5] Univ Ottawa, Bruyere Res Inst, Ottawa, ON, Canada

[6] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[7] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada

[8] Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada

[9] Grey Nuns Hosp, Dept Med, Edmonton, AB, Canada

[10] CHUM Res Ctr, Montreal, PQ, Canada

[11] Ctr Hosp Univ Montreal, Ctr Rech CHUM, Dept Anesthesiol, Div Crit Care, Montreal, PQ, Canada

[12] Ctr Hosp Univ Montreal, Ctr Rech CHUM, Dept Med, Div Crit Care, Montreal, PQ, Canada

[13] Univ Montreal, Dept Anesthesiol & Pain Med, Montreal, PQ, Canada

[14] McMaster Univ, Dept Med, Hamilton, ON, Canada

[15] Vancouver Gen Hosp, Div Cardiol, Vancouver, BC, Canada

[16] Vancouver Gen Hosp, Ctr Cardiovasc Innovat, Vancouver, BC, Canada

[17] Univ British Columbia, Vancouver, BC, Canada

[18] Univ Sherbrooke, Ctr Hosp Univ CHU Sherbrooke, Sherbrooke, PQ, Canada

[19] NHLBI, Bldg 10, Bethesda, MD 20892 USA

[20] St Louis Univ, Sch Med, St. Louis, MO USA

[21] FACT French Alliance Cardiovasc Trials, Paris, France

[22] Sorbonne Univ, Hop St Antoine, AP HP, Serv Pharmacol,Plateforme Rech Clin Est Parisien, Paris, France

[23] Univ Paris Cite, INSERM, Unite 1148, Paris, France

[24] Hop Bichat Claude Bernard, AP HP, Paris, France

[25] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, INSERM UMRS1166,ACTION Study Grp, Paris, France

[26] Univ Paris, Hop Europeen Georges Pompidou, AP HP, Dept Cardiol, Paris, France

[27] CHU Nice, Hop Pasteur, Serv Cardiol, Nice, France

[28] Univ Hosp Poitiers, Clin Invest Ctr, Cardiol Dept, INSERM 1204, Poitiers, France

[29] Montpelier Univ, Nimes Univ Hosp, ACTION Grp, Nimes, France

[30] Duke Univ, Duke Clin Res Inst, Durham, England

[31] WakeMed Hlth & Hosp, Dept Med, Winston Salem, NC USA

[32] Brazilian Clin Res Inst, Sao Paulo, Brazil

[33] Baystate Med Ctr, Dept Med, Springfield, MA USA

[34] Harvard Med Sch, Dept Pathol, Beth Israel Deaconess Med Ctr, Boston, MA USA

[35] Harvard Med Sch, Richard A & Susan F Smith Ctr Outcomes Res Cardio, Beth Israel Deaconess Med Ctr, Boston, MA USA

[36] Univ Nebraska Med Ctr, Omaha, NE USA

[37] Vanderbilt Univ, Dept Med, Med Ctr, Nashville, TN USA

[38] Brown Univ, Lifespan Cardiovasc Inst, Providence, RI USA

[39] Brown Univ, Alpert Med Sch, Dept Med, Div Cardiol, Providence, RI USA

[40] NYU Langone Hlth Syst, Dept Med, New York, NY USA

[41] Montefiore Med Ctr, Dept Med, New York, NY USA

[42] Westchester Med Ctr, Dept Cardiol, Valhalla, NY USA

[43] Univ Louisville, Dept Med, Louiville, KY USA

[44] UChicago AdventHlth Heart & Vasc, Chicago, IL USA

[45] Univ Chicago Med, Dept Med, Chicago, IL USA

[46] Green Lane Coordinating Ctr, Auckland, New Zealand

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2023年 / 389卷 / 26期

基金：

加拿大健康研究院;

关键词：

MAJOR CARDIOVASCULAR EVENTS; RED-CELL TRANSFUSION; OUTCOMES;

D O I：

10.1056/NEJMoa2307983

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundA strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.MethodsIn this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.ResultsA total of 3504 patients were included in the primary analysis. The mean (+/- SD) number of red-cell units that were transfused was 0.7 +/- 1.6 in the restrictive-strategy group and 2.5 +/- 2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).ConclusionsIn patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)

引用

页码：2446 / 2456

页数：11

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