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To the Editor: We are concerned by the conclusion of the study by Dr Rao and colleagues¹ that use of blood transfusion in patients with acute coronary syndromes is associated with higher mortality. The results are inconsistent with previous studies of transfusion use in patients with ischemic heart disease. Our previous study² of 78 974 Medicare beneficiaries hospitalized with myocardial infarction (which used medical record data, not administrative billing data as was suggested in the article) demonstrated a mortality reduction associated with transfusion use in patients with a hematocrit of 30% or less. Moreover, our findings are similar to an earlier report of a transfusion-associated survival benefit in patients with ischemic heart disease.³ The 3 randomized studies^4-6 cited as evidence of no transfusion benefit enrolled 25, 38, and 99 patients, respectively, and thus may have been insufficiently powered to detect any survival difference. In contrast, the largest randomized controlled trial of . . . [Full Text of this Article]

Saif S. Rathore, MPH
saif.rathore@yale.edu

Martha J. Radford, MD; Harlan M. Krumholz, MD, SM
Section of Cardiovascular Medicine
Department of Internal Medicine
Yale University School of Medicine
New Haven, Conn

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