Document Detail


Interaction of age and preoperative risk factors in predicting operative mortality for coronary bypass surgery.
MedLine Citation:
PMID:  1423998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Models for predicting operative mortality for coronary bypass surgery assume that preoperative risk factors affect mortality to the same extent in all patients groups. METHODS AND RESULTS: To determine whether certain preoperative risk factors disproportionately increase operative mortality in the elderly, 663 consecutive elderly patients (age 75 years or older) and 1,464 younger patients (age 65 or younger) undergoing isolated coronary bypass surgery between 1982 and 1990 were studied. Hospital mortality was significantly greater in the elderly patients than in younger patients (7.5% versus 1.8%; relative risk, 4.5). Univariate analysis identified age, prior coronary artery bypass grafting, congestive heart failure, left main disease, New York Heart Association functional class, hypertension, prior myocardial infarction (MI), and preoperative atrial fibrillation as associated with mortality. Multivariate analysis was then used to construct a model to describe the risk of operative mortality in terms of selected risk factors. However, comparison of observed mortality rates with those predicted by the model revealed problems with the model's goodness of fit. Further testing revealed that young patients without prior MI had a mortality rate lower by an order of magnitude than either younger patients with prior MI or elderly patient groups with and without MI. Two separate models were therefore constructed stratifying by the presence of prior MI. This resulted in a significant improvement in the fit of the models to the observed data. CONCLUSIONS: These results suggest that the impact of risk factors on the elderly may be significantly different from the effect of these risk factors on younger patients. Models for predicting outcome after bypass surgery should be tested for potential interactions between age and risk factors.
Authors:
S S Khan; J M Kupfer; J M Matloff; T P Tsai; S Nessim
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  86     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1992 Nov 
Date Detail:
Created Date:  1992-12-02     Completed Date:  1992-12-02     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  II186-90     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac-Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Cohort Studies
Coronary Artery Bypass / mortality*
Female
Hospital Bed Capacity, 500 and over
Hospital Mortality
Humans
Los Angeles
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care) / statistics & numerical data*
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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