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J Thorac Cardiovasc Surg 1998;116:460-464
© 1998 Mosby, Inc.

Surgery for Adult Cardiovascular Disease

Hematocrit value on intensive care unit entry influences thefrequency of q-wave myocardial infarction after coronary artery bypass grafting

Bruce D. Spiess, MD, Catherine Ley, PhD, Simon C. Body, MB, ChB, Lawrence C. Siegel, MD, E. Price Stover, MD, Rosemarie Maddi, MD, Michael D'Ambra, MD, Uday Jain, MD, Fong Liu, MSPH, Ahvie Herskowitz, MD, Dennis T. Mangano, PhD, MD, Jack Levin, MD

The Institutions of the Multicenter Study of Perioperative Ischemia(McSPI) Research Group

See Appendixes 1 and 2 for list of McSPIinvestigators and central analysis group members.

Objectives: No data exist regarding"the best" hematocrit value after coronary artery bypass graftsurgery. Transfusion practice varies, because neither an optimal hematocritvalue nor a uniform transfusion trigger criterion has been determined.
Methods: To investigate the optimal hematocrit value, westudied 2202 patients undergoing coronary bypass. The hematocrit value on entryinto the intensive care unit (IHCT) was categorized into three groups: high (>=34%),medium (25% to 33%), and low (24%). Characteristics andadverse events (outcomes) were compared, and the effect of IHCT on the risk ofmyocardial infarction was determined by logistic regression.
Results: High IHCT (>=34%) was associated with anincreased rate of myocardial infarction (8.3% vs 5.5% vs 3.6%;P 0.03, high, medium vs low) and with moresevere left ventricular dysfunction (11.7% vs 7.4% and 5.7%;P = 0.006, high, medium vs low). Mortalityrate increased with higher IHCT when all the high-risk subgroups were combined(8.6% vs 4.5% vs 3.2%; P <0.001, high, medium vs low). By multivariate analysis, IHCT remained the mostsignificant predictor of adverse outcomes (relative risk high vs low 2.22, 95%confidence interval: 1.04 to 4.76). No characteristic, event, medication, ortransfusion therapy confounded the relationship between IHCT and outcome.
Conclusion: High IHCT is associated with a higher rate ofmyocardial infarction and is an independent predictor of infarction. On thebasis of the risk of myocardial infarction, there is no rationale fortransfusion to an arbitrary level after coronary artery bypass grafting. (JThorac Cardiovasc Surg 1998;116:460-7)




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