This interesting retrospective study showed that red blood cell transfusion is associated with troponin release after elective off-pump coronary artery bypass surgery independently of hemoglobin and hematocrit. This suggests that blood transfusion itself affects myocardial injury rather than through anemia. In addition, the results emphasize that prevention of transfusion, by reduction of perioperative blood loss for example, would be an important target in these surgeries.

– Hiroshi Morimatsu