Blood transfusion in elderly patients with acute myocardial infarction.
Blood transfusion in elderly patients with acute myocardial infarction.
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DOI：
10.1056/nejmoa010615
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发表时间：
2001-10-25
影响因子：
158.5
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Wu, WC;Rathore, SS;Krumholz, HM
背景：贫血可能对冠状动脉疾病患者产生不利影响。然而，输血对于患有急性心肌梗死和不同程度贫血的老年患者的益处尚不确定。方法：我们对 78,974 名 65 岁或以上因急性心肌梗死住院的医疗保险受益人的数据进行了回顾性研究。根据入院时的血细胞比容对患者进行分类（5.0%至24.0%、24.1%至27.0%、27.1%至30.0%、30.1%至33.0%、33.1%至36.0%、36.1%至39.0%或39.1%至48.0%），并评估数据以确定两者之间是否存在关联。使用输血和 30 天死亡率。结果：入院时血细胞比容值较低的患者 30 天死亡率较高。入院时血细胞比容范围为 5.0% 至 24.0%（调整后比值比，0.22；95% 置信区间，0.11 至 0.45）至 30.1% 至 33.0%（调整后比值比，0.69；95% 置信区间，0.53 至 0.53）的患者，输血与 30 天死亡率降低相关。 0.89）。对于血细胞比容值处于较高范围的人来说，这与 30 天死亡率的降低无关。在七个亚组分析之一（存活至少两天的患者中）中，对于红细胞比容值为 30.1% 或更高的患者，输血与死亡率降低无关。结论：如果入院时红细胞比容为 30.0% 或更低，输血与老年急性心肌梗死患者较低的短期死亡率相关，并且对于入院时红细胞比容高达 33.0% 的患者可能有效。
Background: Anemia may have adverse effects in patients with coronary artery disease. However, the benefit of blood transfusion in elderly patients with acute myocardial infarction and various degrees of anemia is uncertain.Methods: We conducted a retrospective study of data on 78,974 Medicare beneficiaries 65 years old or older who were hospitalized with acute myocardial infarction. Patients were categorized according 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 48.0 percent), and data were evaluated to determine whether there was an association between the use of transfusion and 30-day mortality.Results: Patients with lower hematocrit values on admission had higher 30-day mortality rates. Blood transfusion was associated with a reduction in 30-day mortality among patients whose hematocrit on admission fell into the categories ranging from 5.0 to 24.0 percent (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 was not associated with a reduction in 30-day mortality among those whose hematocrit values fell in the higher ranges. In one of seven subgroup analyses (among patients who survived at least two days), transfusion was not associated with a reduction in mortality for patients with hematocrit values of 30.1 percent or higher.Conclusions: Blood transfusion is associated with a lower short-term mortality rate among elderly patients with acute myocardial infarction if the hematocrit on admission is 30.0 percent or lower and may be effective in patients with a hematocrit as high as 33.0 percent on admission.