PB0012 - Restrictive versus Liberal Transfusion Strategy for Anemic Patients with Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Roger Kou

Student
McMaster University
Hamilton, Ontario, Canada

Co-Author(s)

JP

Jane Jungyoon Park

Student
McMaster University
Hamilton, Ontario, Canada
Allen Li

Research Appointee
McMaster University, Department of Medicine
Ottawa, Ontario, Canada
ML

Marissa Laureano

Clinical Fellow
McMaster University, Michael D. DeGroote School of Medicine
Hamilton, Ontario, Canada
MC

Mark Crowther, MD MSc

Professor
Department of Medicine, McMaster University
Hamilton, Ontario, Canada

Background: The optimal blood transfusion threshold for patients with acute myocardial infarction (MI) and anemia is unclear.

Aims: This meta-analysis aimed to assess the safety of restrictive transfusion thresholds to liberal thresholds.

Methods: We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing different transfusion strategies in patients with acute MI. Studies were excluded if they were: non-randomized, animal studies, comparisons of other interventions, evaluating a different target population, or were in progress. Screening, data extraction, evaluation of methodological quality, and quality assessment of the body of evidence were conducted by two reviewers, with disagreement resolved through consensus and input of a third reviewer. Primary outcomes were all measured at 30-days post-randomization and included: All-cause mortality, heart failure, recurrent MI, and stroke. A random-effects model was used.

Results: Our search yielded a total of 7631 results. Three studies were eligible and were included in the analysis (n = 820 patients). In all studies, the restrictive and liberal thresholds were 8g/dL and 10g/dL hemoglobin, respectively. There was no significant difference in All-cause mortality (RR = 0.63; 95% CI 0.15-2.66; P = 0.53; I2 = 59%), Heart failure (RR = 1.17; 95% CI 0.31-4.34; P = 0.82; I2 = 70%), Recurrence of MI (RR = 1.61; 95% CI 0.65-4.02; P = 0.30; I2 = 0%), or Stroke (RR = 1.41; 95% CI 0.27-7.43; P = 0.69; I2 = 0%).

Conclusion(s): Our meta-analysis found no significant difference in the primary outcomes between liberal and restrictive transfusion strategies for patients with acute MI. We advise clinicians to interpret our results with caution given the degree of heterogeneity, the limited sample size, and high imprecision in the results from each outcome.