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.
RCT Entities:
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.
Authors: Karl F Welke; T Bruce Ferguson; Laura P Coombs; Rachel S Dokholyan; Cindy J Murray; Mary A Schrader; Eric D Peterson Journal: Ann Thorac Surg Date: 2004-04 Impact factor: 4.330
Authors: F D Loop; B W Lytle; D M Cosgrove; R W Stewart; M Goormastic; G W Williams; L A Golding; C C Gill; P C Taylor; W C Sheldon Journal: N Engl J Med Date: 1986-01-02 Impact factor: 91.245
Authors: G W Barsness; E D Peterson; E M Ohman; C L Nelson; E R DeLong; J G Reves; P K Smith; R D Anderson; R H Jones; D B Mark; R M Califf Journal: Circulation Date: 1997-10-21 Impact factor: 29.690
Authors: John H Braxton; Charles A S Marrin; Paul D McGrath; Jeremy R Morton; Mitchell Norotsky; David C Charlesworth; Stephen J Lahey; Robert Clough; Cathy S Ross; Elaine M Olmstead; Gerald T O'Connor Journal: Semin Thorac Cardiovasc Surg Date: 2004
Authors: J D Birkmeyer; H B Quinton; N J O'Connor; M D McDaniel; B J Leavitt; D C Charlesworth; F Hernandez; M A Ricci; G T O'Connor Journal: Arch Surg Date: 1996-03
Authors: Stephen W Waldo; Eric A Secemsky; Cashel O'Brien; Kevin F Kennedy; Eugene Pomerantsev; Thoralf M Sundt; Edward J McNulty; Benjamin M Scirica; Robert W Yeh Journal: Circulation Date: 2014-11-12 Impact factor: 29.690
Authors: Yijun Shao; April F Mohanty; Ali Ahmed; Charlene R Weir; Bruce E Bray; Rashmee U Shah; Douglas Redd; Qing Zeng-Treitler Journal: AMIA Annu Symp Proc Date: 2017-02-10
Authors: Timothy S Lancaster; Matthew R Schill; Jason W Greenberg; Chawannuch Ruaengsri; Richard B Schuessler; Jennifer S Lawton; Hersh S Maniar; Michael K Pasque; Marc R Moon; Ralph J Damiano; Spencer J Melby Journal: Ann Thorac Surg Date: 2017-12-19 Impact factor: 4.330
Authors: Miklos D Kertai; Shan Zhou; Jörn A Karhausen; Mary Cooter; Edmund Jooste; Yi-Ju Li; William D White; Solomon Aronson; Mihai V Podgoreanu; Jeffrey Gaca; Ian J Welsby; Jerrold H Levy; Mark Stafford-Smith; Joseph P Mathew; Manuel L Fontes Journal: Anesthesiology Date: 2016-02 Impact factor: 7.892
Authors: Jason C Kovacic; Atul M Limaye; Samantha Sartori; Paul Lee; Roshan Patel; Sweta Chandela; Biana Trost; Swathi Roy; Rafael Harari; Birju Narechania; Rucha Karajgikar; Michael C Kim; Prakash Krishnan; Pedro Moreno; Usman Baber; Roxana Mehran; George Dangas; Annapoorna S Kini; Samin K Sharma Journal: Catheter Cardiovasc Interv Date: 2013-07-01 Impact factor: 2.692
Authors: Justin P Fox; Lisa G Suter; Karen Wang; Yongfei Wang; Harlan M Krumholz; Joseph S Ross Journal: Ann Thorac Surg Date: 2013-05-21 Impact factor: 4.330