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

Objectives: 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.