This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: July 14, 2009, Volume 120, Number 2 All Versions of this Article: 120/2/118    most recent CIRCULATIONAHA.109.854216v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by van Straten, A. H.M. Articles by de Wolf, A. M. PubMed PubMed Citation Articles by van Straten, A. H.M. Articles by de Wolf, A. M. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Coronary Artery Bypass Surgery Coronary Artery Disease Related Collections CV surgery: coronary artery disease Related Article

(Circulation. 2009;120:118-125.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

Preoperative Hemoglobin Level as a Predictor of Survival After Coronary Artery Bypass Grafting

A Comparison With the Matched General Population

Albert H.M. van Straten, MD; Mohamed A. Soliman Hamad, MD; André J. van Zundert, MD, PhD, FRCA; Elisabeth J. Martens, PhD; Jacques P.A.M. Schönberger, MD, PhD; Andre M. de Wolf, MD

From the Department of Cardio-Thoracic Surgery (A.H.M.v.S., M.A.S.H., J.P.A.M.S.), Department of Education and Research (E.J.M.), and Department of Anesthesiology, Brabant Medical School (A.J.v.Z.), Catharina Hospital, Eindhoven, the Netherlands; Department of Anesthesiology (A.J.v.Z.), University Hospital Ghent, Ghent, Belgium; and Department of Anesthesiology (A.M.d.W.), the Feinberg School of Medicine, Northwestern University, Chicago, Ill.

Correspondence to M.A. Soliman Hamad, MD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, The Netherlands. E-mail aasmsn{at}cze.nl

Received January 27, 2009; accepted May 15, 2009.

Background— The predictive value of the preoperative hemoglobin value after coronary artery bypass grafting (CABG) has not been well established. We studied how the preoperative hemoglobin level affects the survival of patients after CABG. Late mortality was compared with that of a general population.

Methods and Results— Early and late mortality of all consecutive patients undergoing isolated CABG between January 1998 and December 2007 were determined. Patients were classified into 4 groups stratified by preoperative hemoglobin level. The cutoff point for anemia was 13 g/dL for men and 12 g/dL for women. Expected survival of a matched general Dutch population cohort was obtained from the database of the Dutch Central Bureau for Statistics. After the exclusion of 122 patients who were lost to follow-up and 481 patients with missing preoperative hemoglobin levels, complete data were obtained in 10 025 patients. Multivariate logistic regression analyses revealed anemia to be an independent risk factor for higher early mortality. Cox regression analyses revealed low hemoglobin level, both as a continuous variable and as a dichotomous variable (anemia), to be a predictor of higher late mortality. Compared with expected survival, patients with the lowest preoperative hemoglobin levels had a worse outcome, whereas patients with the highest hemoglobin levels had a better outcome.

Conclusions— A lower preoperative hemoglobin level is an independent predictor of late mortality in patients undergoing CABG, whereas anemia is a risk factor for early and late mortality. Compared with the general population, anemic patients had worse survival than expected, whereas nonanemic patients had better survival than expected.

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Circulation 2009 120: 97-98. [Extract] [Full Text]