美国罗格斯大学Jeffrey L. Carson团队研究了心肌梗死和贫血患者接受限制性或自由输血策略对预后的影响。相关论文于2023年11月11日发表在《新英格兰医学杂志》上。

只有当血红蛋白水平降至每分升7或8克以下时才进行输血的策略已被广泛采用。然而，急性心肌梗死患者可能受益于较高的血红蛋白水平。

在这项3期介入试验中，研究组将血红蛋白水平低于每分升10克的心肌梗死患者随机分为限制性输血策略（输血时血红蛋白截止值为每分升7或8克）或自由输血策略（血红蛋白截止值<10克）。主要结局是30天内心肌梗死复发或死亡的综合结局。

共有3504名患者被纳入初步分析。限制性策略组输注的红细胞单位平均数（±SD）为0.7±1.6，自由策略组为2.5±2.3。随机化后第1-3天，限制性策略组的平均血红蛋白水平比自由策略组低1.3至1.6克/分升。限制性策略组1749名患者中有295名（16.9%）发生了主要结局事件，而自由策略组1755名患者中有255名（14.5%）发生（采用不完全随访多重插补建模的风险比为1.15；95%置信区间[CI]为0.99-1.34；P=0.07）。9.9%的限制性策略组患者和8.3%的自由策略组患者死亡（风险比1.19；95%可信区间0.96-1.47）；心肌梗死发生率分别为8.5%和7.2%（风险比1.19；95%可信区间0.94-1.49）。

研究结果表明，在急性心肌梗死和贫血患者中，自由输血策略并不能显著降低30天时复发性心肌梗死或死亡的风险。但限制性输血策略的潜在危害亦不能排除。

附：英文原文

Title: Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia | NEJM

Author: anonymous

Issue&Volume: 2023-11-11

Abstract:

Background

A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.

Methods

In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.

Results

A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).

Conclusions

In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded.

DOI: 10.1056/NEJMoa2307983

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2307983