La Dra. Ana Viana Tejedor analiza en La SEC te lleva a ESC20 los resultados del estudio publicado en ESC Congress 2020.

1. Ana Viana TejedorREALITY Trial

2. Ana Viana TejedorREALITY Trial
• Anemia in patients with myocardial infarction (MI) is a relatively
frequent issue, resulting in poorer outcome.
• There is uncertainty as to which transfusion strategy is best.
• RCTs have compared a restrictive and a liberal transfusion strategy
in cardiac and non-cardiac surgery or in patients with GI bleeding but
have excluded patients with acute MI.
BACKGROUND AND RATIONALE
Presentation by Philip Gabriel Steg. ESC Congress 2020

3. Ana Viana TejedorREALITY Trial

4. Ana Viana TejedorREALITY Trial
BACKGROUND AND RATIONALE
• 2017 ESC STEMI Guidelines: no mention.
• 2020 ESC NSTEMI-ACS Guidelines: “based on inconsistent study
results and the lack of adequately powered RCTs, a restrictive policy
of transfusion in anemic patients may be considered”.
No formal recommendation.
• Given the costs and risks of transfusion, a cost-effectiveness and
cost-utility analysis becomes key to determining the role of each
strategy.

5. Ana Viana TejedorREALITY Trial
• Objective: determine the efficacy,
cost-effectiveness and cost-utility
of liberal vs restrictive red
blood cell transfusion strategies
in patients with acute
myocardial infarction and
anaemia.
• Diseño: randomized, open label,
parallel assignment. 630
patients.
• Participating sites: France and
Spain.
Las estrategias debían mantenerse hasta el alta hospitalaria o durante 30 días (lo que sucediese primero). Se permitía
transfundir si: sangrado masivo, se presumía una caída importante de la Hb sin tiempo a esperar la cifra real de Hb, shock tras
la randomización.

6. Ana Viana TejedorREALITY Trial
PATIENT SELECTION

7. Ana Viana TejedorREALITY Trial
HYPOTHESIS AND SAMPLE SIZE

8. Ana Viana TejedorREALITY Trial

9. Ana Viana TejedorREALITY Trial

10. Ana Viana TejedorREALITY Trial
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11. Ana Viana TejedorREALITY Trial

12. Ana Viana TejedorREALITY Trial

13. Ana Viana TejedorREALITY Trial

14. Ana Viana TejedorREALITY Trial

15. Ana Viana TejedorREALITY Trial
1500 €

16. Ana Viana TejedorREALITY Trial

17. Ana Viana TejedorREALITY Trial
CONCLUSIONES
• La estrategia de transfusión restrictiva:
 Es NO INFERIOR a una estrategia liberal para prevenir los MACE a 30 días
en los pacientes con IAM y anemia
 Ahorra sangre
 Es segura
• El análisis de coste-efectividad indica que la estrategia
restrictiva puede ahorrar costes además de mejorar los
resultados (dominante).
• Estos resultados apoyan el uso de una estrategia restrictiva.