Abstract 9286: Patterns of Red Blood Cell Transfusion Use in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Clinical Practice
Background Previous studies have shown marked variation in the use of red blood cell transfusion (RBCT) among patients with acute coronary syndromes. Contemporary post-procedure RBCT patterns in patients undergoing PCI are unclear.
Methods Using the NCDR Cath-PCI database we evaluated frequency of RBCT in 1323965 patients undergoing PCI at 1282 hospitals between 7/2009-9/2011 excluding those who underwent in-hospital CABG. Site-level variation in RBCT use was examined; differences in patient baseline characteristics and in-hospital outcomes were compared between patients who did and did not receive RBCT. Logistic regression was used to determine the adjusted association between RBCT and in-hospital death, MI, or stroke.
Results Of the total sample, 29255(2.2%) patients received RBCT. These patients were older, more often female, and more often had HTN, prior CHF, prior MI, cerebrovascular disease, peripheral arterial disease, diabetes, or be on dialysis. Patients receiving RBCT had lower median pre-procedure Hgb (10.7 g/dl vs 13.7 g/dl, P<0.01) and post-procedure Hgb (8.6 g/dl vs 12.7 g/dl, P<0.01) and more often experienced a post-PCI bleeding event (36% vs 1%, P<0.01). RBCT was more frequent in patients with post-procedure Hgb <10 g/dl, irrespective of PCI indication. With respect to site-level variation, 17% of hospitals gave no RBCT, 76% of hospitals used RBCT in 1-4% of patients, while just 7% of hospitals used RBCT in ≥5% of patients (Figure). After adjustment, the use of RBCT was significantly associated with in-hospital death, MI, or stroke (OR 2.18; 95% CI 2.09-2.26). Similar results were seen after excluding patients who bled.
Conclusions In contemporary PCI practice, there is marked site-level variability in the use of RBCT. After adjustment for potential confounders, RBCT is associated with a higher risk for in-hospital adverse events. These data underscore the importance of understanding the appropriate role of RBCT in patients undergoing PCI.
- © 2012 by American Heart Association, Inc.