Impact of transfusion policy on acute coronary syndrome after major vascular reconstruction.
OBJECTIVE
To investigate the impact of a restrictive transfusion approach, as indicated by accepting a perioperative hemoglobin (Hb) level as low as 8 g/dL, on the incidence of acute coronary syndrome (ACS) and mortality after major vascular reconstruction.


METHODS
Using a case-control design, 45 patients who underwent vascular reconstruction and developed postoperative ACS were compared with 135 patients treated with similar procedures who did not suffer ACS postoperatively.


RESULTS
A history of CAD was more often present in the ACS group (16% vs 56%) and was an independent predictor of ACS (odds ratio [OR] = 6.62; confidence interval [CI], 3.16-13.88; P < .001) and postoperative death (OR = 5.08; CI, 2.0-12.85; P = .001). Postoperative (Hb) levels as low as 8 g/dL were well tolerated and had no impact on the occurrence of ACS (OR = .61; CI, 0.29-1.26; P = .181) or death (OR = 1.33; CI, 0.52-3.43; P = .547). The presence of CAD for a given Hb level did not increase the odds of either ACS (OR = 3.43; CI, .75-15.6; P = .112) or death (OR = 2.02; CI, .5-19.55; P = .543).


CONCLUSIONS
A restrictive transfusion policy is justified in patients undergoing major vascular reconstruction, even in the presence of appropriately managed cad.
Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA. pkougias@bcm.tmc.edu
Panagiotis
P
Kougias
Carlos F
CF
Bechara
Faisal
F
Bakaeen
Danny
D
Chu
Peter H
PH
Lin
D054058:Acute Coronary Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D016001:Confidence Intervals; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D006454:Hemoglobins