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Methods We conducted a retrospective study of data on 78,974 Medicare beneficiaries 65 years old or older who were hospitalized with acute myocardial infarction. Patients were categorized according to the hematocrit on admission (5.0 to 24.0 percent, 24.1 to 27.0 percent, 27.1 to 30.0 percent, 30.1 to 33.0 percent, 33.1 to 36.0 percent, 36.1 to 39.0 percent, or 39.1 to 48.0 percent), and data were evaluated to determine whether there was an association between the use of transfusion and 30-day mortality. Results Patients with lower hematocrit values on admission had higher 30-day mortality rates. Blood transfusion was associated with a reduction in 30-day mortality among patients whose hematocrit on admission fell into the categories ranging from 5.0 to 24.0 percent (adjusted odds ratio, 0.22; 95 percent confidence interval, 0.11 to 0.45) to 30.1 to 33.0 percent (adjusted odds ratio, 0.69; 95 percent confidence interval, 0.53 to 0.89). It was not associated with a reduction in 30-day mortality among those whose hematocrit values fell in the higher ranges.

In one of seven subgroup analyses (among patients who survived at least two days), transfusion was not associated with a reduction in mortality for patients with hematocrit values of 30.1 percent or higher. Anemia is common in the elderly, occurring in 24 to 40 percent of hospitalized patients older than 65 years of age. Although patients with anemia who have coronary artery disease or risk factors for coronary disease have an increased risk of death in the short term, the prognostic importance of anemia in patients who present with acute myocardial infarction is not well defined. Furthermore, there is uncertainty concerning the appropriate role of blood transfusion. Whereas the effectiveness of blood transfusion in patients with gastrointestinal hemorrhage, in patients undergoing cardiac and noncardiac surgery, and in critically ill patients is known, its role in patients with acute coronary syndromes is inadequately characterized.

Current recommendations are based primarily on expert opinion, rather than on published evidence. We sought to determine the risk associated with anemia in patients with acute myocardial infarction and the effectiveness of blood transfusion in a national cohort of elderly patients hospitalized with acute myocardial infarction. The Cooperative Cardiovascular Project The Cooperative Cardiovascular Project (CCP) has been described in detail elsewhere.

Briefly, the CCP was a national program of the Health Care Financing Administration (currently the Centers for Medicare and Medicaid Services) that was developed to improve the quality of care for Medicare beneficiaries with acute myocardial infarction. The 234,769 patients in the CCP cohort constitute a sample of beneficiaries of the fee-for-service program of Medicare who were discharged from nongovernmental acute care hospitals in the United States with a primary diagnosis at discharge of acute myocardial infarction (code 410 of the International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] ) between January 1994 and February 1995, excluding patients for whom the hospitalization had been a readmission for acute myocardial infarction (ICD-9-CM code 410.x2). Study Sample Our cohort was restricted to patients 65 years of age or older who were hospitalized with confirmed acute myocardial infarction. We therefore excluded 17,593 patients younger than 65 years of age, 45,349 patients who did not have confirmed acute myocardial infarction on admission, and 23,773 patients who had been readmitted for acute myocardial infarction. We also excluded 42,278 patients who had been transferred to the study hospital and 39,028 patients who were transferred from the study hospital to another hospital, because we were unable to evaluate their full hospital course.