Lee Seung Hyung, Kim Ji Eon, Lee Jun Ho, Jung Jae Seung, Son Ho Sung, Kim Hee-Jung
Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul 02841, Republic of Korea.
J Clin Med. 2025 Apr 13;14(8):2662. doi: 10.3390/jcm14082662.
: 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. : 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. : 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], < 0.001). Subgroup analysis showed a similar trend in both CCAB and OPCAB groups ( for interaction = 0.2). Transfusion of ≥2 units significantly increased mortality in OPCAB (HR 2.28 [1.55-3.37], < 0.001) but not in CCAB (HR 2.96 [0.97-9.06], = 0.057). OPCAB and surgery at large volume center was associated with a reduced risk of RBC transfusion ( < 0.01). : 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.
不同冠状动脉旁路移植术（CABG）策略，尤其是体外循环与非体外循环技术，对红细胞（RBC）输注及其相关结局的影响尚未得到充分研究。本研究旨在评估CABG患者RBC输注与生存之间的关联，重点关注体外循环策略。：从国家健康保险服务数据库（2003年至2019年）中检索CABG患者的数据。围手术期RBC输注分为三组：未输血、输注1单位RBC和输注≥2单位RBC。主要终点是全因死亡率。亚组分析评估了RBC输注对传统体外循环（CCAB）和非体外循环（OPCAB）组死亡率的影响。：在6150例接受CABG的参与者中，2028例接受CCAB，4122例接受OPCAB。平均年龄为66.2±9.7岁，平均随访2.9（2.53 - 3.35）年。多变量分析显示，输注≥2单位RBC与死亡风险增加显著相关（HR 2.34 [1.65 - 3.32]，P < 0.001）。亚组分析显示CCAB和OPCAB组均有类似趋势（交互作用P = 0.2）。输注≥2单位RBC在OPCAB组显著增加死亡率（HR 2.28 [1.55 - 3.37]，P < 0.001），但在CCAB组未显著增加（HR 2.96 [0.97 - 9.06]，P = 0.057）。OPCAB和在大容量中心进行手术与RBC输注风险降低相关（P < 0.01）。：CABG患者RBC输注增加与更高的长期死亡率相关。基于一个主要由OPCAB患者组成的大型队列，OPCAB与RBC输注需求减少相关。
