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Thorac Cardiovasc Surg 2002; 50(5): 259-265
DOI: 10.1055/s-2002-34575
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Impact of Hematocrit Value after Coronary Artery Surgery on Perioperative Myocardial Infarction Rate

O.  Klass1 , U.  Mehlhorn1 , K.  Zilkens1 , A.  Kröner1 , K.  Hekmat1 , H.  J.  Geissler1 , E.  R.  de Vivie1
  • 1Clinic for Cardiothoracic Surgery, University of Cologne, Cologne, Germany
Presented at the 30th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery February 17 - 21, 2001 Leipzig, Germany
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Publication History

Received June 1, 2002

Publication Date:
08 October 2002 (online)

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Introduction

The optimal hematocrit (HCT) value after coronary artery bypass graft (CABG) surgery is not known. A wide range of transfusion practice after CABG operations exists [1] despite general guidelines for perioperative transfusion of blood and blood products, published by the National Institutes of Health consensus conference on perioperative transfusion of red cells [2], the American College of Physicians [3], and the Canadian Medical Association [4]. It has been speculated that anemia might increase the risk of myocardial ischemia after CABG, but several studies failed to find an association between anemia and morbidity following CABG [5]. Thus, no safe HCT range or “best” HCT value after CABG has been established. The risk for myocardial ischemic events is highest during the immediate perioperative period [6]. A recent study by Spiess et al. [7] assessed the relation between HCT value at the time of entry into the intensive care unit (ICU) and perioperative myocardial infarction rate. They found that perioperative MI rate was significantly lower in patients entering the ICU with a HCT ≤ 24 %, and suggested that HCT values ≤ 24 % protect against perioperative MI [7]. However, their definition of perioperative MI was solely based on ECG changes (Minnesota Code criteria); cardiac enzyme release was not considered [7]. As ECG changes alone may not be sufficient for perioperative MI determination [8], we sought to include cardiac enzyme release in our definition of perioperative MI as suggested by Braunwald et al. [9].