Avoidance of Blood Transfusion to Patients Suffering From Myocardial Injury and Severe Anemia Is Associated With Increased Long-Term Mortality

Abstract

Myocardial injury and anemia are common among patients in internal medicine departments. Nevertheless, the level of anemia in which blood should be given to these patients is ill defined.We conducted a retrospective, cohort analysis.A total of 209 patients hospitalized to internal medicine, with myocardial injury (troponin I > 0.2 mcg/L, not diagnosed as ACS, acute coronary syndrome) and anemia (Hb < 10 g/dL, without overt bleeding) were included. The overall in-hospital mortality rate was 20.7%. A total of 37 patients (17.8%) had severe anemia (Hb < 8 g/dL). A total of 73 patients (34.9%) were transfused. Severe anemia was not associated with increased long-term mortality in the whole cohort while survival of patients with severe anemia that were not transfused was significantly reduced compared to transfused patients (44% vs 80%; P = 0.03). Mortality rates were similar for all patients with Hb ≥ 8 g/dL, regardless of transfusion (54% vs 49%; P = 0.60). Consistently, lack of blood transfusion in patients with severe anemia was independently associated with a 2.27 (1.08–4.81) greater adjusted risk of all-cause mortality (P-value for interaction = 0.04), whereas it did not significantly increase in patients with Hb ≥ 8 g/dL.Avoidance of blood transfusion is associated with unfavorable outcomes among patients with myocardial injury and severe anemia.

Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

“…Hematocrit <30% was included as a predictor for mortality in their model. Barbarova et al [ 20 ] conducted a retrospective cohort analysis of 209 consecutive patients suffering from myocardial injury, with concomitant anemia. In their study, Hb <8 g/dL was found to be an independent risk factor reducing survival in patients not receiving RBC transfusions when compared to transfused patients, whereas no significant difference was observed in patients with Hb ≥8 g/dL between the 2 groups.…”

Impact of low hemoglobin on the development of contrast-induced nephropathy: A retrospective cohort study

“…Furthermore, Shah et al ( 42 ) reported that the risk associated with low levels of hemoglobin is greater in patients with myocardial infarction than for those with stable angina. Therefore, a previous study treated anemic patients with myocardial injury with blood transfusions and demonstrated favorable outcomes ( 44 ). In addition, patients with coronary artery disease are given treatment to maintain their hemoglobin concentrations at a minimum of 100 g/l ( 45 ).…”

Turkish Society of Cardiology Consensus Paper onThe Rational Use of Cardiac Troponins in Daily Practice

“…Severe anemia has also been found to relate with mortality in patients with MI and HF (134, 135). Barbarova et al (136) showed that patients with severe anemia and elevated troponin levels presenting to internal medicine departments due to non-cardiac problems had worse long-term survival if they did not get blood transfusion. The main reason of the increase in cTn in case of severe anemia may be resultant tissue hypoxia leading to myocardial injury.…”