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Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention.

ABSTRACT: Studies have shown variation in the use of red blood cell transfusion among patients with acute coronary syndromes. There are no definitive data for the efficacy of transfusion in improving outcomes, and concerning data exist about possible association with harm. Current transfusion practices in patients undergoing percutaneous coronary intervention (PCI) are not well understood.To determine the current patterns of blood transfusion among patients undergoing PCI and the association of transfusion with adverse cardiac outcomes across hospitals in the United States.Retrospective cohort study of all patient visits from the CathPCI Registry from July 2009 to March 2013 that included PCI, excluding those with missing data on bleeding complications or who underwent in-hospital coronary artery bypass graft surgery (N?=?2,258,711 visits).Transfusion rates in the overall population and by hospital (N?=?1431) were the primary outcomes. The association of transfusion with myocardial infarction, stroke, and death after accounting for a patient's propensity for transfusion was also measured.The overall rate of transfusion was 2.14% (95% CI, 2.13%-2.16%) and quarterly transfusion rates slightly declined from July 2009 to March 2013 (from 2.11% [95% CI, 2.03%-2.19%] to 2.04% [95% CI, 1.97%-2.12%]; P?

SUBMITTER: Sherwood MW

PROVIDER: S-EPMC4276400 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention.

Sherwood Matthew W MW Wang Yongfei Y Curtis Jeptha P JP Peterson Eric D ED Rao Sunil V SV

JAMA 20140201 8

<h4>Importance</h4>Studies have shown variation in the use of red blood cell transfusion among patients with acute coronary syndromes. There are no definitive data for the efficacy of transfusion in improving outcomes, and concerning data exist about possible association with harm. Current transfusion practices in patients undergoing percutaneous coronary intervention (PCI) are not well understood.<h4>Objective</h4>To determine the current patterns of blood transfusion among patients undergoing ...[more]

PMID: 24570247

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Project description:BackgroundNeurotensin is involved in fatty acid and glucose metabolism and promotes the development of obesity and diabetes. These associations appear to be more pronounced in women. We investigated the association of neurotensin with long-term major adverse cardiovascular events (MACE) in patients presenting with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).MethodsWe included 452 consecutive patients [144 (31.9%) females] undergoing PCI for ACS or CCS. Plasma samples drawn after PCI were analyzed for neurotensin with an enzyme-linked immunoassay. As primary endpoint, a composite of MACE including all-cause death, non-fatal myocardial infarction and non-fatal stroke during 7 years of follow-up was investigated. As secondary endpoint, we investigated all-cause death.ResultsNeurotensin levels did not differ between male and female patients (p = 0.560). MACE occurred in 150 (33.2%) patients. Restricted cubic splines demonstrated a U-shaped association of log-transformed neurotensin with the primary and secondary endpoint. Therefore, we dichotomized our cohort according to tertiles of log-transformed neurotensin. In Kaplan-Meier analysis including the total cohort and restricted to male patients log- neurotensin tertiles were not associated with MACE (both p > 0.05). Moreover, in the overall cohort and in male patients multivariable Cox regression analysis log-neurotensin tertiles were not associated with MACE or with all-cause death (all p > 0.05). However, in female patients log-neurotensin was associated with MACE in Kaplan-Meier analysis (log-rank p = 0.013). Also, after multivariable adjustment female patients in the first tertile had a significantly increased risk for MACE compared to female patients in the second tertile [HR 3.84 (95% CI 1.71-8.60), p = 0.001]. There was tendency for increased risk in female patients in the third tertile compared to the second tertile [HR 2.14 (95% CI 0.97-4.73), p = 0.058]. Moreover, in female patients the [first and the third tertile of log- neurotensin were associated with all-cause death 1s vs. 2nd tertile: HR 3.03 (95% CI 1.21-7.63), p = 0.018; 3rd vs. 2nd tertile: HR 3.01 (95% CI 1.22-7.44), p = 0.016].ConclusionIn female patients with CAD undergoing PCI, neurotensin has a U-shaped relationship with adverse outcomes. These data suggest a sex specific association between neurotensin and long-term adverse events after PCI.

Project description:Background: Evidence on factors associated with guideline-directed secondary prevention medication (GDPM) after percutaneous coronary intervention (PCI) and its effect on the prognosis of patients with coronary artery disease (CAD) is lacking in China. Aims: To ascertain predictors of GDPM in real-world clinical practice and to assess the effect of GDPM on clinical outcomes. Design: A retrospective cohort study. Methods: Consecutive patients admitted to Fuwai Hospital between January 2013 and December 2013 were recruited. GDPM comprised aspirin, clopidogrel, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers. The primary outcome was five-year major adverse cardiovascular event (MACE) (cardiac death, myocardial infarction [MI] and unplanned revascularization). Multivariable logistic regression was used to identify predictors of prescribing GDPM. Multivariable Cox regression was used to examine the relationship between GDPM and clinical outcomes. Results: 10,067 patients were followed up for a median of 5.0 years (interquartile range: 4.3–5.2), 45.1% were prescribed with GDPM. Presenting with ST-segment elevation MI (adjusted OR = 3.252 [2.832–3.736]), prior MI (adjusted OR = 2.174 [1.948–2.425]), more stents implanted (adjusted OR = 1.063 [1.022–1.106]), overweight (adjusted OR = 1.136 [1.038–1.243]), obesity (adjusted OR = 1.274 [1.100–1.476]), diabetes (adjusted OR = 1.225 [1.115–1.344]), and hypertension (adjusted OR = 3.556 [3.196–3.956]) predicted the prescription of GDPM. Advanced age (adjusted OR = 0.556 [0.379–0.816]) was associated with lower prescription rate of GDPM. Patients with GDPM had lower rate of 5-year MACE (adjusted HR = 0.889 [0.808–0.978]) relative to those without GDPM. Conclusions: Despite the benefit of GDPM in improving the prognosis of CAD patients undergoing PCI, gaps still exist in GDPM prescription in real-world clinical practice. Our study determined target populations for physicians to strive to promote the application of GDPM.

Dataset Information

Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention.

Publications

Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention.

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