? ? FOCUS is a randomized clinical trial funded by the NHLBI designed to test the hypothesis that a higher blood transfusion threshold improves functional recovery and reduces morbidity and mortality. Patients who undergo surgery for hip fracture, have a history of cardiovascular disease, and have a postoperative hemoglobin (Hgb) level less than 10 g/dL within 3 days of surgery are eligible. Patients will be randomly assigned either to receive enough blood to raise the Hgb above 10 g/dL or to receive transfusion if symptoms of anemia develop; transfusion is permitted but not required if Hgb is less than 8 g/dL. The primary outcome is ability to walk 10 feet (or across a room) without human assistance at 60 days. ? ? A critical concern among clinicians is whether withholding transfusion in patients with perioperative anemia increases the risk of postoperative acute cardiac events. Recent observational studies have emphasized the importance of anemia and transfusion in the outcomes of patients with coronary artery disease. However, there has never been a randomized clinical trial that has evaluated the effect of transfusion thresholds on the postoperative risk of acute cardiac ischemic events, i.e. acute coronary syndromes, myocardial infarction. The current study protocol detects acute myocardial ischemic events such as myocardial infarction (Ml) by recording the results of cardiac biomarkers and electrocardiograms (ECG) obtained as part of usual clinical care. The goal of this new proposal is to support systematic detection of Ml. We recently obtained a non competing supplement that provides partial support for acquisition and storage of serum for cardiac troponin measurement and ECGs. Thus, we are currently collecting the necessary information and specimens for the diagnosis of Ml. This supplemental application seeks support for a Troponin Core Laboratory for measurement of troponin concentrations, and an ECG Core Laboratory to analyze the ECGs and to classify all postoperative acute coronary ischemic events. Resources are also requested to support continued collection of serum fortrooonin measurement and ECG's. ? ?
