Abstract 3301: Blood Transfusion and Mortality Among Patients with Non-ST-segment Elevation Acute Coronary Syndromes: Results from CRUSADE
Background: Blood transfusions (BT) are commonly given in the course of acute coronary syndromes (ACS) care, yet their association with mortality is complex. Prior studies differed in adjustment for hematocrit (HCT), bleeding events, and treatment, resulting in unclear risk/benefit in this setting.
Methods: We examined 44,242 patients (pts) with non-ST-segment elevation (NSTE) ACS enrolled in 400 hospitals from the CRUSADE initiative from 1/04 to 12/05. The association of BT with in-hospital mortality was examined as a function of the lowest reported HCT overall and after adjustment for clinical factors using a generalized estimating equations method.
Results: Overall, 10.4% of pts with NSTE ACS received non-CABG related BT, and 3.9% died. Risk of in-hospital mortality varied as a function of lowest reported HCT (Table⇓). BT with a nadir HCT of <24% was associated with a trend to lower mortality (adj. OR 0.75 [0.50–1.12]). Mortality rates were similar with BT vs. no BT for pts with nadir HCT 24–27% or HCT 27–30% (adj. OR 1.01 [0.79–1.28] and adj. OR 1.14 [0.90–1.46], respectively). Only among pts with a nadir HCT ≥30% was mortality higher with BT (adj. OR 2.89 [1.85– 4.51]). However, pts with BT and a nadir HCT ≥30% were more likely to have witnessed bleeding events than pts with BT and nadir HCT <30% (43.3 v. 30.2%, respectively).
Conclusions: Our data provide new insights into the association of BT with mortality during NSTE ACS care. While BT might be beneficial in severe anemia (HCT <24%), our data do not support harm or benefit in the range of treatment indecision (HCT 24–30%). BT when HCT ≥30% was associated with higher mortality, but this may reflect a risk of active bleeding rather than BT itself.