Transfusion may improve survival in older anaemic patients with myocardial injury

Blood transfusion appears to result in better 30-day outcomes in older anaemic patients with anaemia-related myocardial injury, according to a study. Hence, troponin levels may be included in decision-making relative to transfusion in this population.

“Anaemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration,” the researchers said.

To address this knowledge gap, a retrospective study was conducted for 2 years in an acute geriatric unit, including 514 patients (median age 88 years) with haemoglobin <10 g/dL and troponin sampling. Then, the researchers compared 30-day and 1-year mortality according to transfusion status as well as troponin and haemoglobin levels.

Of the anaemic patients, 157 (31 percent) had elevated troponin concentrations. These patients had a greater likelihood of dying at 30 days (49 percent vs 27 percent; p<0.001) and at 1 year (65 percent vs 51 percent; p=0.004) compared to those with normal values.

Among patients with elevated troponin concentrations, those who had had transfusion tended to have lower 30-day mortality than their not-transfused counterparts (hazard ratio [HR], 0.48, 95 percent confidence interval [CI], 0.21‒1.08; p=0.07). Such association was not present in patients without troponin elevation (HR, 1.09, 95 percent CI, 0.61‒1.93; p=0.8).

Of note, transfusion correlated with 30-day survival in patients with haemoglobin ≤8 g/dL and with excess 1-year mortality in those with haemoglobin >8 g/dL.

“Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins,” the researchers said.