Blood transfusions adversely affect PCI outcomes

Transfusion receipt linked to adverse cardiovascular events, regardless of bleeding complications.

Variation Seen in Blood Transfusion Practices After PCI
Variation Seen in Blood Transfusion Practices After PCI

HealthDay News -- For patients undergoing percutaneous coronary intervention (PCI), blood transfusion rates and practices vary among hospitals and transfusion receipt is associated with adverse coronary outcomes, study findings indicate.

Transfusion rates in patients undergoing PCI ranged from 0.3% to 9.3%, Matthew W. Sherwood, MD, from the Duke Clinical Research Institute in Durham, N.C., and colleagues reported in the Journal of the American Medical Association.

And use of transfusion was associated with greater risks of myocardial infarction (MI), stroke and death during the initial hospital stay, they found.

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

The study involved data from more than 2.2 million patient visits that included PCI performed at 1,431 hospitals from the CathPCI Registry from July 2009 to March 2013. Patients who also underwent CABG during the same hospital stay were excluded.

PCI was elective in 44.2%, urgent in 38.8%, emergent in 16.7% and salvage in 0.3%.

The overall transfusion rate was 2.14% during the study period, with the rate decreasing slightly over time (from 2.11% to 2.04%, P<0.001). Older patients, women, and patients with hypertension, diabetes, advanced renal dysfunction, and prior MI or heart failure were more likely to receive transfusion.

Overall, 3.7% of sites gave a transfusion to 5% of patients or more, while 96.3% gave a transfusion to less than 5% of patients. After adjustment, the variation in hospital risk-standardized transfusion rates persisted, and there was variability seen in hospital transfusion thresholds.

Regardless of bleeding complications, the following outcomes were more likely in patients who received a transfusion:

  • MI: 4.5% vs. 1.8% (OR 2.60; 95% CI 2.57-2.63)
  • Stroke: 2% vs. 0.2% (OR 7.72; 95% CI 7.47-7.98)
  • In-hospital death: 12.5% vs. 1.2% (OR 4.63; 95% CI 4.57-4.69)

"Among patients undergoing PCI at U.S. hospitals, there was considerable variation in blood transfusion practices, and receipt of transfusion was associated with increased risk of in-hospital adverse cardiac events," the researchers concluded.

Two authors disclosed financial ties to the pharmaceutical and medical device industries.

References

  1. Sherwood M et al. JAMA. 2014; 311: 836-843.
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