Document Detail

Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study).
MedLine Citation:
PMID:  22361330     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Most survival prediction models for coronary artery bypass grafting surgery are limited to in-hospital or 30-day end points. We estimate a long-term survival model using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and Centers for Medicare and Medicaid Services.
METHODS AND RESULTS: The final study cohort included 348 341 isolated coronary artery bypass grafting patients aged ≥65 years, discharged between January 1, 2002, and December 31, 2007, from 917 Society of Thoracic Surgeons-participating hospitals, randomly divided into training (n=174 506) and validation (n=173 835) samples. Through linkage with Centers for Medicare and Medicaid Services claims data, we ascertained vital status from date of surgery through December 31, 2008 (1- to 6-year follow-up). Because the proportional hazards assumption was violated, we fit 4 Cox regression models conditional on being alive at the beginning of the following intervals: 0 to 30 days, 31 to 180 days, 181 days to 2 years, and >2 years. Kaplan-Meier-estimated mortality was 3.2% at 30 days, 6.4% at 180 days, 8.1% at 1 year, and 23.3% at 3 years of follow-up. Harrell's C statistic for predicting overall survival time was 0.732. Some risk factors (eg, emergency status, shock, reoperation) were strong predictors of short-term outcome but, for early survivors, became nonsignificant within 2 years. The adverse impact of some other risk factors (eg, dialysis-dependent renal failure, insulin-dependent diabetes mellitus) continued to increase.
CONCLUSIONS: Using clinical registry data and longitudinal claims data, we developed a long-term survival prediction model for isolated coronary artery bypass grafting. This provides valuable information for shared decision making, comparative effectiveness research, quality improvement, and provider profiling.
David M Shahian; Sean M O'Brien; Shubin Sheng; Frederick L Grover; John E Mayer; Jeffrey P Jacobs; Jocelyn M Weiss; Elizabeth R Delong; Eric D Peterson; William S Weintraub; Maria V Grau-Sepulveda; Lloyd W Klein; Richard E Shaw; Kirk N Garratt; Issam D Moussa; Cynthia M Shewan; George D Dangas; Fred H Edwards
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, American Recovery and Reinvestment Act; Research Support, N.I.H., Extramural     Date:  2012-02-23
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-27     Completed Date:  2012-08-13     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1491-500     Citation Subset:  AIM; IM    
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MeSH Terms
Cohort Studies
Coronary Artery Bypass / mortality*,  trends*
Databases, Factual / trends*
Follow-Up Studies
Predictive Value of Tests
Societies, Medical / trends*
Thoracic Surgery / trends*
Grant Support
Comment In:
Circulation. 2012 Mar 27;125(12):1475-6   [PMID:  22361328 ]
Circulation. 2012 Oct 16;126(16):e258   [PMID:  23071181 ]

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

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