Impact of transfusion policy on acute coronary syndrome after major vascular reconstruction

ObjectivesTo 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.MethodsUsing 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.ResultsA 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).ConclusionsA restrictive transfusion policy is justified in patients undergoing major vascular reconstruction, even in the presence of appropriately managed cad.