Photo Credit: Toeytoey2530
The following is a summary of “Liberal versus restrictive transfusion strategies in acute myocardial infarction: a systematic review and comparative frequentist and Bayesian meta-analysis of randomized controlled trials,” published in the September 2024 issue of Critical Care by Braïk et al.
Researchers conducted a retrospective study to assess the impact of liberal vs restrictive transfusion strategies on mortality during the acute phase of myocardial infarction (AMI).
They systematically searched MEDLINE, EMBASE, and the COCHRANE library databases, focusing on randomized controlled trials (RCTs). The primary endpoint was the latest measured mortality within 90 days following myocardial infarction (MI). Secondary endpoints included recurrence of MI, cardiovascular mortality, stroke occurrence, unplanned revascularization, and a composite endpoint of death or recurrent MI. Mixed and random-effects models were employed to estimate relative risks. Sensitivity analyses were conducted using 2 approaches: by incorporating only studies assessed as low risk of bias according to the Rob2 tool and another employing a Bayesian analysis.
The results showed that 4,324 participants were analyzed with 4 RCTs. Neither fixed-effect nor random-effects models demonstrated a significant reduction in mortality, with risk ratios (RR) of 1.16 (95% CI 0.95–1.40) for the fixed-effect model and 1.13 (95% CI 0.67–1.91) for the random-effects model (GRADE: low certainty of evidence). Sensitivity analyses were constant with the primary analysis. For the composite outcome death or MI, both fixed-effect and random-effects models showed a statistically significant RR of 1.18 (95% CI 1.01–1.37) with negligible heterogeneity (I2= 0%, P=0.46), indicating results unfavorable to restrictive transfusion (GRADE: very low certainty of evidence). However, this result was primarily driven by a single study. For cardiac mortality, the fixed-effects model indicated a significant RR of 1.42 (95% CI 1.07–1.88), whereas the random-effects model showed a non–significant RR of 1.05 (95% CI 0.36–3.80). Analyses of other secondary endpoints did not show statistically significant results.
Investigators concluded that the analysis did not show a significant benefit in early mortality with a liberal transfusion strategy compared to a restrictive strategy for AMI while suggesting that liberal transfusion might reduce the composite outcome of death or MI, with very low certainty of evidence.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01376-1
