title: Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery: insights from the IMAGINE trial.
abstract: OBJECTIVE
  To investigate the association between sustained postoperative anaemia and outcome after coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Retrospective analysis of the IMAGINE trial, which tested the effect of the ACE inhibitor quinapril on cardiovascular events after CABG.
  
  
  METHODS
  Thoracic surgery clinic/outpatient department.
  
  
  METHODS
  2553 stable patients with left ventricular ejection fraction >40% 2-7 days after scheduled CABG.
  
  
  METHODS
  Randomisation to quinapril or placebo.
  
  
  METHODS
  Cox regression analysis for the association between postoperative anaemia and cardiovascular events and the effect of quinapril on the incidence of anaemia.
  
  
  RESULTS
  Postoperative anaemia was sustained for >50 days in 44% of patients. Sustained postoperative anaemia was associated with an increased incidence of cardiovascular events during the first 3 months (adjusted HR (adjHR) 1.77, 95% CI 1.10 to 2.85, p=0.012) and during the maximum follow-up of 43 months (adjHR 1.37, 95% CI 1.14 to 1.65, p=0.008). When haemoglobin (Hb) was considered as a continuous variable, every 1 mg/dl decrease in Hb was associated with a 13% increase in cardiovascular events (adjHR 0.87, 95% CI 0.81 to 0.95, p=0.003) and a 22% increase in all-cause mortality (adjHR 0.78, 95% CI 0.60 to 0.99, p=0.034). Quinapril was associated with a slower postoperative recovery of Hb levels and a higher incidence of cardiovascular events in patients with anaemia (adjHR 1.60, 95% CI 1.1 to 2.4, p=0.024).
  
  
  CONCLUSIONS
  Postoperative anaemia is common, frequently persists for months after CABG surgery and is associated with an impaired outcome. In patients with anaemia, ACE inhibitors slowed recovery from postoperative anaemia and increased the incidence of cardiovascular events after CABG.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, P O Box 30001, Groningen 9700 RB, The Netherlands. b.d.westenbrink@thorax.umcg.nl
authors.forename: B Daan
authors.initials: BD
authors.lastname: Westenbrink
authors.forename: Lennaert
authors.initials: L
authors.lastname: Kleijn
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Warnica
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D000077583:Quinapril; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D006454:Hemoglobins; D044005:Tetrahydroisoquinolines; D000077583:Quinapril