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To the Editor: From their observational study, Dr Vincent and colleagues¹ reported that transfusion was associated with an increased risk of mortality at all hematocrit levels in a heterogeneous group of critically ill patients. In their accompanying Editorial, Drs Hébert and Fergusson² suggested that this study provides evidence concerning the role of transfusion in patients with ischemic heart disease. We disagree.

In a larger, observational study of patients with acute myocardial infarction we found that transfusions were associated with opposite results—ie, a reduction in mortality for patients with a hematocrit of 33% or less.³ Both of these observational studies are susceptible to bias, but we believe the reason for the disparity between the findings is most likely due to differences in the populations studied. In the study of Vincent et al, a minority of patients were primarily admitted for coronary ischemic heart disease, and only 104 of the 702 treated . . . [Full Text of this Article]