The additive effects of anaemia and transfusion on long-term survival after coronary artery bypass surgery

Data de publicação: 01/01/2024

Autores da FMUP

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

Participantes de fora da FMUP

• Abreu A.
• Máximo J.
• Almeida C.
• Lourenço A.

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

OBJECTIVES: To compare the independent and combined effects of anaemia and red blood cell transfusion on late survival after isolated coronary artery bypass grafting. METHODS: Retrospective analysis of 5243 consecutive patients undergoing primary isolated coronary artery bypass grafting, performed from 2000 to 2015, in a Portuguese Academic Hospital. We identified 1649 patients with preoperative anaemia (Aþ) and 1422 patients who received a perioperative transfusion (Tþ)—the 4 possible combinations allowed for the creation of 4 subgroups (A-/T-, A-/Tþ, Aþ/T- and Aþ/Tþ). The primary endpoint was all-cause mortality at 10 years. We employed inverse probability weighting to control for confounding variables. RESULTS: Thirty-one percent of the patients had preoperative anaemia, and 27.0% had at least one packed red blood cell transfusion. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. The primary endpoint of all-cause mortality at 10 years occurred in 568 patients (20.5%) in the A-/T- group, as compared with 204 (24.4%) in the A-/Tþ group (hazard ratio, 1.14; 95% confidence interval, 1.00 to 1.31; P=0.053), 358 (33.8%) in the Aþ/T- group (hazard ratio, 1.53; 95% confidence interval, 1.38 to 1.71; P<0.001), 254 (43.6%) in the Aþ/Tþ group (hazard ratio, 2.25; 95% confidence interval, 1.97 to 2.56; P<0.001). CONCLUSIONS: This longitudinal, population-level study emphasizes the adverse long-term outcomes of preoperative anaemia and perioperative red blood cell transfusion. It stresses the importance of an evidence-based, multimodal and multidisciplinary approach to conserving blood resources and optimizing outcomes in patients at high risk for transfusion. © The Author(s) 2023.

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Keywords

• Anemia; Blood Transfusion; Coronary Artery Bypass; Erythrocyte Transfusion; Humans; Retrospective Studies; hemoglobin; acute kidney failure; additive effect; adult; aged; anemia; Article; artificial ventilation; cerebrovascular accident; chronic obstructive lung disease; confidence interval; congestive heart failure; coronary artery bypass surgery; creatinine clearance; diabetes mellitus; erythrocyte transfusion; female; hemoglobin determination; hospitalization; human; hyperlipidemia; hypertension; ICD-9-CM; internal mammary artery; long term survival; major clinical study; male; middle aged; mortality; non ST segment elevation myocardial infarction; peripheral vascular disease; propensity score; retrospective study; ST segment elevation myocardial infarction; unstable angina pectoris; anemia; blood transfusion; complication; coronary artery bypass graft