Background Anemia may have adverse effects in patients withcoronary artery disease. However, the benefit of blood transfusionin elderly patients with acute myocardial infarction and variousdegrees of anemia is uncertain.
Methods We conducted a retrospective study of data on 78,974Medicare beneficiaries 65 years old or older who were hospitalizedwith acute myocardial infarction. Patients were categorizedaccording to the hematocrit on admission (5.0 to 24.0 percent,24.1 to 27.0 percent, 27.1 to 30.0 percent, 30.1 to 33.0 percent,33.1 to 36.0 percent, 36.1 to 39.0 percent, or 39.1 to 48.0percent), and data were evaluated to determine whether therewas an association between the use of transfusion and 30-daymortality.
Results Patients with lower hematocrit values on admission hadhigher 30-day mortality rates. Blood transfusion was associatedwith a reduction in 30-day mortality among patients whose hematocriton admission fell into the categories ranging from 5.0 to 24.0percent (adjusted odds ratio, 0.22; 95 percent confidence interval,0.11 to 0.45) to 30.1 to 33.0 percent (adjusted odds ratio,0.69; 95 percent confidence interval, 0.53 to 0.89). It wasnot associated with a reduction in 30-day mortality among thosewhose hematocrit values fell in the higher ranges. In one ofseven subgroup analyses (among patients who survived at leasttwo days), transfusion was not associated with a reduction inmortality for patients with hematocrit values of 30.1 percentor higher.
Conclusions Blood transfusion is associated with a lower short-termmortality rate among elderly patients with acute myocardialinfarction if the hematocrit on admission is 30.0 percent orlower and may be effective in patients with a hematocrit ashigh as 33.0 percent on admission.
Source Information
From the Division of Cardiovascular Diseases, Brown University Medical School, Providence, R.I. (W.-C.W.); the Section of Cardiovascular Medicine, Department of Medicine (S.S.R., Y.W., M.J.R., H.M.K.), and the Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.), Yale University School of Medicine, and Yale–New Haven Hospital Center for Outcomes Research and Evaluation (M.J.R., H.M.K.) — both in New Haven, Conn.; and Qualidigm, Middletown, Conn. (M.J.R., H.M.K.).
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