title: Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery.
abstract: BACKGROUND
  The risk of preoperative anemia in patients undergoing heart surgery has not been described precisely. Specifically, the impact of low hemoglobin per se or combined with other risk factors on postoperative outcome is unknown. Thus, we determined the effects of low preoperative hemoglobin and comorbidities on postoperative adverse outcomes in patients with coronary artery bypass graft in a large comprehensive multicenter study.
  
  
  RESULTS
  The Multicenter Study of Perioperative Ischemia investigated 5065 patients with coronary artery bypass graft at 70 institutions worldwide, collecting approximately 7500 data points per patient. In 4804 patients who received no preoperative transfusions, we determined the association between lowest preoperative hemoglobin levels and in-hospital cardiac and noncardiac morbidity and mortality and the impact of concomitant risk factors, assessed by EuroSCORE, on this effect. In patients with EuroSCORE < 4 (n=2054), only noncardiac outcomes were increased, whereas patients with EuroSCORE > or = 4 (n=2750) showed an increased incidence of all postoperative events, starting at hemoglobin < 11 g/dL. Low preoperative hemoglobin was an independent predictor for noncardiac (renal > cerebral; P<0.001) outcomes, whereas the increase in cardiac events was due to other factors associated with preoperative anemia.
  
  
  CONCLUSIONS
  Anemic patients undergoing cardiac surgery have an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affects perioperative anemia tolerance. Therefore, preoperative risk assessment and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative hemoglobin and the extent of concomitant risk factors.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austri. akulier@aon.at
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulier
authors.forename: Jack
authors.initials: J
authors.lastname: Levin
authors.forename: Rita
authors.initials: R
authors.lastname: Moser
authors.forename: Gudrun
authors.initials: G
authors.lastname: Rumpold-Seitlinger
authors.forename: Iulia Cristina
authors.initials: IC
authors.lastname: Tudor
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Snyder-Ramos
authors.forename: Patrick
authors.initials: P
authors.lastname: Moehnle
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Mangano
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D004198:Disease Susceptibility; D017707:Erythrocyte Transfusion; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000601:surgery; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000517:prevention & control; D007239:Infections / Q000209:etiology; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007501:Iron / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010949:Plasma; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D007501:Iron