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To the Editor: In their study of risk of aprotinin, Dr Mangano and colleagues¹ found that aprotinin was associated with increased long-term risk of mortality following CABG surgery when compared with nonaprotinin antifibrinolytics. There are some covariates that are important to consider in this type of study, and it is not clear from this article whether they were included in the analysis.

First, low preoperative hemoglobin levels are correlated with worse CABG outcomes.² Therefore, this variable should have been included in the statistical models. Also, it does not appear that adjustment was made for intraoperative hemoglobin level during CABG surgery, which can influence outcome.³ There is a dose-dependent association between blood transfusion and the development of severe postoperative infection and death in patients undergoing cardiac surgery.⁴

Second, CABG outcomes are influenced by anastomosis of the internal thoracic artery to the left anterior descending artery as well as degree of critical . . . [Full Text of this Article]

Jeffrey Shuhaiber, MD
jeffrey01@mac.com
Department of Thoracic and Cardiovascular Surgery
Loyola University Stritch School of Medicine
Chicago, Ill

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