Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease

Jeffrey L. Carson, Maria Mori Brooks, J. Dawn Abbott, Bernard Chaitman, Sheryl F. Kelsey, Darrell J. Triulzi, Vankeepuram Srinivas, Mark A. Menegus, Oscar C. Marroquin, Sunil V. Rao, Helaine Noveck, Elizabeth Passano, Regina M. Hardison, Thomas Smitherman, Tudor Vagaonescu, Neil J. Wimmer, David O. Williams

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Abstract

Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin >10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level 10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin >8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial. (Am Heart J 2013;165:964- 971.e1.).

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume165
Issue number6
DOIs
StatePublished - Jun 2013

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Coronary Artery Disease
Hemoglobins
Acute Coronary Syndrome
Stable Angina
Cardiac Catheterization
Random Allocation
Anemia
Age Groups
Myocardial Infarction
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Carson, J. L., Brooks, M. M., Abbott, J. D., Chaitman, B., Kelsey, S. F., Triulzi, D. J., ... Williams, D. O. (2013). Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. American Heart Journal, 165(6). https://doi.org/10.1016/j.ahj.2013.03.001

Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. / Carson, Jeffrey L.; Brooks, Maria Mori; Abbott, J. Dawn; Chaitman, Bernard; Kelsey, Sheryl F.; Triulzi, Darrell J.; Srinivas, Vankeepuram; Menegus, Mark A.; Marroquin, Oscar C.; Rao, Sunil V.; Noveck, Helaine; Passano, Elizabeth; Hardison, Regina M.; Smitherman, Thomas; Vagaonescu, Tudor; Wimmer, Neil J.; Williams, David O.

In: American Heart Journal, Vol. 165, No. 6, 06.2013.

Research output: Contribution to journalArticle

Carson, JL, Brooks, MM, Abbott, JD, Chaitman, B, Kelsey, SF, Triulzi, DJ, Srinivas, V, Menegus, MA, Marroquin, OC, Rao, SV, Noveck, H, Passano, E, Hardison, RM, Smitherman, T, Vagaonescu, T, Wimmer, NJ & Williams, DO 2013, 'Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease', American Heart Journal, vol. 165, no. 6. https://doi.org/10.1016/j.ahj.2013.03.001
Carson, Jeffrey L. ; Brooks, Maria Mori ; Abbott, J. Dawn ; Chaitman, Bernard ; Kelsey, Sheryl F. ; Triulzi, Darrell J. ; Srinivas, Vankeepuram ; Menegus, Mark A. ; Marroquin, Oscar C. ; Rao, Sunil V. ; Noveck, Helaine ; Passano, Elizabeth ; Hardison, Regina M. ; Smitherman, Thomas ; Vagaonescu, Tudor ; Wimmer, Neil J. ; Williams, David O. / Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. In: American Heart Journal. 2013 ; Vol. 165, No. 6.
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abstract = "Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin >10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level 10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin >8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9{\%}) in the liberal group and 14 (25.5{\%}) in the restrictive group (risk difference = 15.0{\%}; 95{\%} confidence interval of difference 0.7{\%} to 29.3{\%}; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8{\%}) compared to restrictive group (n = 7, 13.0{\%}; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial. (Am Heart J 2013;165:964- 971.e1.).",
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T1 - Coronary artery disease liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease

AU - Carson, Jeffrey L.

AU - Brooks, Maria Mori

AU - Abbott, J. Dawn

AU - Chaitman, Bernard

AU - Kelsey, Sheryl F.

AU - Triulzi, Darrell J.

AU - Srinivas, Vankeepuram

AU - Menegus, Mark A.

AU - Marroquin, Oscar C.

AU - Rao, Sunil V.

AU - Noveck, Helaine

AU - Passano, Elizabeth

AU - Hardison, Regina M.

AU - Smitherman, Thomas

AU - Vagaonescu, Tudor

AU - Wimmer, Neil J.

AU - Williams, David O.

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N2 - Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin >10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level 10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin >8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial. (Am Heart J 2013;165:964- 971.e1.).

AB - Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin >10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level 10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin >8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial. (Am Heart J 2013;165:964- 971.e1.).

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