{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:33:56Z","timestamp":1772253236291,"version":"3.50.1"},"reference-count":39,"publisher":"Sociedade Brasileira de Cardiologia","issue":"9","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo  Fundamento: A estrat\u00e9gia \u00f3tima de transfus\u00e3o na anemia associada ao infarto agudo do mioc\u00e1rdio (IAM) ainda \u00e9 desconhecida.  Objetivos: Comparar a mortalidade por todas as causas entre as estrat\u00e9gias de transfus\u00e3o liberal versus restritiva em pacientes com anemia associada a IAM, por meio de uma metan\u00e1lise.  M\u00e9todos: Conduzimos uma busca sistem\u00e1tica nos bancos de dados Pubmed, Embase, e ClinicalTrials.gov por ensaios cl\u00ednicos randomizados (ECRs) comparando estrat\u00e9gias de transfus\u00e3o liberal e restritiva na anemia associada a IAM. Uma metan\u00e1lise de efeitos aleat\u00f3rios e uma an\u00e1lise sequencial de ensaios cl\u00ednicos foram conduzidas para comparar o uso de hem\u00e1cias, a efic\u00e1cia e desfechos de seguran\u00e7a. Os valores p adotados foram bicaudais, com um \u03b1 de 0,05.  Resultados: Em uma an\u00e1lise agrupada envolvendo 4217 participantes de tr\u00eas ECRs acompanhados por 30 dias, n\u00e3o foram identificadas diferen\u00e7as entre as estrat\u00e9gias restritiva e liberal quanto a mortalidade por todas as causas (RR 1,03; IC 95% 0,67\u20131,57; p=0,90) e outros desfechos de efic\u00e1cia (IAM recorrente, revasculariza\u00e7\u00e3o n\u00e3o programada, insufici\u00eancia card\u00edaca aguda, e les\u00e3o renal aguda), bem como desfechos de seguran\u00e7a incluindo rea\u00e7\u00f5es al\u00e9rgicas, infec\u00e7\u00e3o, e les\u00e3o pulmonar aguda. A an\u00e1lise sequencial dos ensaios n\u00e3o atingiu o limiar de futilidade. Nos pacientes alocados para a estrat\u00e9gia restritiva, foram observadas diferen\u00e7as substanciais na transfus\u00e3o utilizada entre os ECRs, correlacionadas \u00e0s taxas de mortalidade, e provavelmente contribuindo para a heterogeneidade dos efeitos do tratamento entre os estudos.  Conclus\u00f5es: Em pacientes com anemia associada a IAM, n\u00e3o h\u00e1 uma clara superioridade entre estrat\u00e9gias de transfus\u00e3o restritiva e liberal quanto \u00e0 mortalidade por todas as causas ou outros desfechos maiores em 30 dias. No entanto, a heterogeneidade observada no uso de sangue entre os grupos submetidos \u00e0 transfus\u00e3o restritiva provavelmente explica a variabilidade dos achados entre os ECRs.<\/jats:p>","DOI":"10.36660\/abc.20240158","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T09:04:54Z","timestamp":1730279094000},"source":"Crossref","is-referenced-by-count":1,"title":["Estrat\u00e9gias de Transfus\u00e3o Restritiva versus Liberal em Infarto Agudo do Mioc\u00e1rdio e Anemia: Metan\u00e1lise e An\u00e1lise Sequencial de Ensaios Cl\u00ednicos"],"prefix":"10.36660","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8559-3073","authenticated-orcid":false,"given":"Ronaldo C.","family":"Fabiano","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center,  EUA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5435-6158","authenticated-orcid":false,"given":"Lara","family":"Melo","sequence":"additional","affiliation":[{"name":"University of Connecticut,  EUA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5995-6179","authenticated-orcid":false,"given":"Alleh","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-2445","authenticated-orcid":false,"given":"Douglas M.","family":"Gewehr","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1010-2428","authenticated-orcid":false,"given":"Giuliano","family":"Generoso","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3622-7605","authenticated-orcid":false,"given":"Rhanderson","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Harvard Medical School,  EUA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3711-1754","authenticated-orcid":false,"given":"Marcio S.","family":"Bittencourt","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil; University of Pittsburgh Medical Center,  EUA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22636","published-online":{"date-parts":[[2024]]},"reference":[{"issue":"12","key":"ref1","article-title":"Transfusion Thresholds for Guiding Red Blood Cell Transfusion","volume":"12","author":"Carson JL","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"issue":"22","key":"ref2","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1056\/NEJMoa1711818","article-title":"Restrictive or Liberal Red-cell Transfusion for Cardiac Surgery","volume":"377","author":"Mazer CD","year":"2017","journal-title":"N Engl J Med"},{"issue":"26","key":"ref3","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1056\/NEJMoa1012452","article-title":"Liberal or Restrictive Transfusion in High-risk Patients after Hip Surgery","volume":"365","author":"Carson JL","year":"2011","journal-title":"N Engl J Med"},{"issue":"6","key":"ref4","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1056\/NEJM199902113400601","article-title":"A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care. 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