Restricting blood transfusion in myocardial infarction patients with anemia to those with very low hemoglobin levels saved blood and did not have a negative impact on clinical outcomes, according to findings from the REALITY trial presented at ESC Congress 2020.

The trial enrolled 668 patients hospitalized at 35 centers in France and Spain with acute myocardial infarction and anemia (hemoglobin 10 g/dL or below, but above 7 g/dL). Patients were randomly allocated to either a restrictive transfusion strategy (transfusion withheld unless hemoglobin dropped to 8 g/dL) or a liberal transfusion strategy (transfusion given as soon as hemoglobin was 10 g/dL or below). All patients were followed-up for 30 days. The primary clinical endpoint was a composite of major adverse cardiac events (MACE) at 30 days. In addition, a cost effectiveness endpoint was the incremental cost effectiveness ratio at 30 days.

Results showed the restrictive transfusion strategy was non-inferior to the liberal strategy in preventing 30-day MACE. The primary clinical outcome occurred in 36 patients (11%) in the restrictive strategy group compared with 45 patients (14%) in the liberal strategy group. In terms of cost effectiveness, researchers noted the restrictive strategy had an 84% probability of being cost-saving while improving clinical outcomes. In addition, researchers found the restrictive strategy safer than the liberal strategy, with patients in the restrictive group significantly less likely to develop an infection or acute lung injury.

"Blood is a precious resource, and transfusion is costly, logistically cumbersome, and has side effects," said principal investigator Philippe Gabriel Steg, MD, FACC, of Hospital Bichat in Paris. "The REALITY trial supports the use of a restrictive strategy for blood transfusion in myocardial infarction patients with anemia. The restrictive strategy saves blood, is safe, and is at least as effective in preventing 30-day cardiac events compared to a liberal strategy, while saving money."

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC Congress, ESC20, Myocardial Infarction, Acute Coronary Syndrome, Angiography, Percutaneous Coronary Intervention

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