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Home > Vascular Annual Meeting > PVSS21. Impact of Transfusion Policy on Acute Coronary...

PVSS21. Impact of Transfusion Policy on Acute Coronary Syndrome After Major Vascular Reconstruction

Panos Kougias, MD; William F. Johnston, MS; Catherine Cagiannos, MD; Tam T. Huynh, MD; Carlos F. Bechara, MD; Peter H. Lin, MD
Baylor College of Medicine, Houston, TX

OBJECTIVES: Multiple blood transfusions have been associated with inferior outcomes in critically ill individuals, generating guidelines favoring restrictive transfusion policies. Vascular surgery patients are at high risk for acute coronary syndrome (ACS) due to coexistence of vascular and coronary artery disease (CAD). This study was designed to investigate the impact of a restrictive transfusion approach, as indicated by accepting a perioperative hemoglobin (Hb) level as low as 8 gm/dl, on the incidence of 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 to 135 patients treated with similar procedures who did not suffer ACS postoperatively. Fisher’s exact test was employed to compare categorical variables. Logistic regression, which included an equation with interaction expansion variables for CAD and perioperative Hb levels, was used to assess the relative impact of these two variables on the occurrence of ACS.

RESULTS: Comorbidities such as pulmonary disease, hypertension, renal insufficiency, diabetes, and hyperlipidemia were equally distributed between the groups and had no impact on the occurrence of ACS or death. History of CAD that had been optimally managed preoperatively, was more often present in the ACS group (16 vs. 56%) and was independent predictor of ACS (OR:6.62, CI:3.16-13.88, p<0.001) and postoperative death (OR:5.08, CI:2.0-12.85, p=0.001). Postoperative hemoglobin (Hb) levels as low as 8 gm/dl were well tolerated and had no impact on the occurrence of ACS (OR:0.61, CI:0.29-1.26, p=0.181) or death (OR:1.33, CI:0.52-3.43, p=0.547). The presence of CAD did not increase the odds of either ACS (OR:3.43, CI:0.75-15.6, p=0.112) or death (OR:2.02, CI:0.5-19.55, p=0.543).

CONCLUSIONS: Our findings indicate that a restrictive transfusion policy is justified in patients undergoing major vascular reconstruction, even in the presence of appropriately managed CAD. Further prospective studies are needed to clarify the impact of transfusion policy on outcomes among vascular surgery patients.

AUTHOR DISCLOSURES: P. Kougias, None; W.F. Johnston, None; C. Cagiannos, None; T.T. Huynh, None; C.F. Bechara, None; P.H. Lin, None.