title: Transfusion in coronary artery bypass grafting is associated with reduced long-term survival.
abstract: BACKGROUND
  Perioperative red blood cell (PRBC) transfusion has been associated with early risk for morbid outcomes, but risk related to long-term survival has not been thoroughly explored. Therefore, we examined the influence of PRBC transfusion and component therapy on long-term survival after isolated coronary artery bypass grafting after controlling for the effect of demographics, comorbidities, operative factors, and the early hazard for death.
  
  
  METHODS
  The US Social Security Death Index was used to ascertain survival status for 10,289 patients who underwent isolated coronary artery bypass grafting from January 1, 1995 through June 28, 2002. The outcome measure was all-cause mortality during the follow-up period. Unadjusted survival estimates were performed using the Kaplan-Meier techniques. Survival curves for transfusion status were compared with the log-rank test. The parametric decomposition model was used for risk-adjusted survival. A balancing score was calculated for each patient and forced into the final model.
  
  
  RESULTS
  Survival among transfused patients was significantly reduced as compared with nontransfused patients. The instantaneous risk of death displayed a biphasic pattern: a declining hazard phase from the time of the operation (early hazard) up until 6 months postoperatively and then a late hazard that continued out until about 10 years. Transfusion of red cells was associated with a risk-adjusted reduction in survival for both the early (0.34 +/- 0.02, p < 0.0001) and late phases (0.074 +/- 0.016, p < 0.0001).
  
  
  CONCLUSIONS
  Perioperative PRBC transfusion is associated with adverse long-term sequela in isolated CABG. Attention should be directed toward blood conservation methods and a more judicious use of PRBC.
authors.affiliation: Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. kochc@ccf.org
authors.forename: Colleen Gorman
authors.initials: CG
authors.lastname: Koch
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: Andra I
authors.initials: AI
authors.lastname: Duncan
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Floyd D
authors.initials: FD
authors.lastname: Loop
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Starr
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000367:Age Factors; D001663:Bilirubin / Q000097:blood; D015992:Body Mass Index; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D003404:Creatinine; D001663:Bilirubin