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Perioperative Red Blood Cell Transfusion and Long-Term Mortality in Coronary Artery Bypass Grafting: On-Pump and
Seung Hyung Lee1, Ji Eon Kim1, Jun Ho Lee1
1Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul 02841, Republic of Korea.
Insights
Red blood cell (RBC) transfusions, especially two or more units, are linked to higher mortality after coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) reduces RBC transfusion needs.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) involves on-pump and off-pump strategies.
- The impact of red blood cell (RBC) transfusions on CABG outcomes requires further investigation.
Purpose of the Study:
- To evaluate the association between RBC transfusion and survival in CABG patients.
- To compare outcomes between on-pump (CCAB) and off-pump (OPCAB) CABG strategies regarding RBC transfusion.
Main Methods:
- Retrieved data from 6150 CABG patients (2003-2019) from the National Health Insurance Service database.
- Classified perioperative RBC transfusions into no transfusion, 1 unit, and ≥2 units.
- Conducted multivariable and subgroup analyses comparing CCAB and OPCAB groups.
Main Results:
- Transfusion of ≥2 RBC units was associated with increased all-cause mortality (HR 2.34).
- This association was significant in OPCAB (HR 2.28) but not in CCAB (HR 2.96, p=0.057).
- OPCAB and high-volume centers reduced RBC transfusion risk.
Conclusions:
- Increased RBC transfusion correlates with higher long-term mortality post-CABG.
- OPCAB strategy is associated with reduced RBC transfusion requirements in a large patient cohort.
Abstract:
Background/Objectives: The impact of different coronary artery bypass grafting (CABG) strategies, particularly on-pump versus off-pump techniques, on red blood cell (RBC) transfusions and their associated outcomes has not been fully investigated. This study aims to evaluate the association between RBC transfusion and survival in CABG patients, focusing on-pump strategy. Methods: Data from CABG patients were retrieved from the National Health Insurance Service database (2003 to 2019). Perioperative RBC transfusions were classified into three groups: no transfusion, RBC 1, and RBC ≥ 2 units. The primary endpoint was all-cause mortality rate. Subgroup analysis assessed the impact of RBC transfusion on mortality across the conventional on-pump (CCAB) and off-pump (OPCAB) groups. Results: Among the 6150 participants who underwent CABG, 2028 underwent CCAB and 4122 underwent OPCAB. The mean age was 66.2 ± 9.7 years, with a mean follow-up of 2.9 (2.53-3.35) years. Multivariable analysis showed a significant association between transfusion of ≥2 RBC units and increased mortality risk (HR 2.34 [1.65-3.32], p < 0.001). Subgroup analysis showed a similar trend in both CCAB and OPCAB groups (p for interaction = 0.2). Transfusion of ≥2 units significantly increased mortality in OPCAB (HR 2.28 [1.55-3.37], p < 0.001) but not in CCAB (HR 2.96 [0.97-9.06], p = 0.057). OPCAB and surgery at large volume center was associated with a reduced risk of RBC transfusion (p < 0.01). Conclusions: Increased RBC transfusion is associated with higher long-term mortality in patients undergoing CABG. Based on a large cohort predominantly consisting of OPCAB patients, OPCAB is associated with decreased RBC transfusion requirements.
