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Ann Thorac Surg 2002;73:480-489
© 2002 The Society of Thoracic Surgeons
a The Society of Thoracic Surgeons National Database Committee, Chicago, Illinois, USA
b Duke University Clinical Research Institute, Durham, North Carolina, USA
* Address reprint requests to Dr Ferguson, LSU Health Sciences Center, 1542 Tulane Ave, 7 Fl, New Orleans, LA 70012-2822, USA
e-mail: tbruceferg732{at}pol.net
Background. The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999.
Methods. Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval.
Results. Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients’ predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality.
Conclusions. Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, CABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.
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 C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]
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G. N. Djaiani Aortic arch atheroma: stroke reduction in cardiac surgical patients. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 143 - 157. [Abstract] [PDF]
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S. Karthik, N. Tahir, B. Thakur, and U. Nair Risk factor awareness and secondary prevention of coronary artery disease: are we doing enough? Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 268 - 271. [Abstract] [Full Text] [PDF]
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M. Cladellas, J. Bruguera, J. Comin, J. Vila, E. de Jaime, J. Marti, and M. Gomez Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? Eur. Heart J., May 1, 2006; 27(9): 1093 - 1099. [Abstract] [Full Text] [PDF]
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A. P. Kappetein, K. D. Dawkins, F. W. Mohr, M. C. Morice, M. J. Mack, M. E. Russell, J. Pomar, and P. W.J.C. Serruys Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 486 - 491. [Abstract] [Full Text] [PDF]
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 L. Abrahamyan, A. Demirchyan, M. E Thompson, and H. Hovaguimian Determinants of Morbidity and Intensive Care Unit Stay after Coronary Surgery Asian Cardiovasc Thorac Ann, April 1, 2006; 14(2): 114 - 118. [Abstract] [Full Text] [PDF]
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L. J. Shaw, C. N. Bairey Merz, C. J. Pepine, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S4 - S20. [Abstract] [Full Text] [PDF]
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C. N. Bairey Merz, L. J. Shaw, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, C. J. Pepine, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: Gender Differences in Presentation, Diagnosis, and Outcome With Regard to Gender-Based Pathophysiology of Atherosclerosis and Macrovascular and Microvascular Coronary Disease J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S21 - S29. [Abstract] [Full Text] [PDF]
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A. K. Jacobs Women, Ischemic Heart Disease, Revascularization, and the Gender Gap: What Are We Missing? J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S63 - S65. [Abstract] [Full Text] [PDF]
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G. Asimakopoulos, A. P. Karagounis, O. Valencia, D. Rose, G. Niranjan, and V. Chandrasekaran How Safe Is It to Train Residents to Perform Off-Pump Coronary Artery Bypass Surgery? Ann. Thorac. Surg., February 1, 2006; 81(2): 568 - 572. [Abstract] [Full Text] [PDF]
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I. K. Toumpoulis, C. E. Anagnostopoulos, S. K. Balaram, C. K. Rokkas, D. G. Swistel, R. C. Ashton Jr, and J. J. DeRose Jr Assessment of independent predictors for long-term mortality between women and men after coronary artery bypass grafting: Are women different from men? J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 343 - 351. [Abstract] [Full Text] [PDF]
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F. Seccareccia, C. A. Perucci, P. D'Errigo, M. Arca, D. Fusco, S. Rosato, D. Greco, and on behalf of the research group of the Italian CAB The Italian CABG Outcome Study: short-term outcomes in patients with coronary artery bypass graft surgery Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 56 - 62. [Abstract] [Full Text] [PDF]
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J. W. Hammon, D. A. Stump, J. F. Butterworth, D. M. Moody, K. Rorie, D. D. Deal, E. H. Kincaid, T. E. Oaks, and N. D. Kon Single crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: The effect of reduced aortic manipulation J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 114 - 121. [Abstract] [Full Text] [PDF]
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F. Toraman, H. Karabulut, O. Goksel, S. Evrenkaya, S. Tarcan, and C. Alhan Comparison of Antihypertensives after Coronary Artery Surgery Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 302 - 306. [Abstract] [Full Text] [PDF]
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S. V Ghotkar, A. D Grayson, and W. C Dihmis Effect of Prolonged Intensive Care Stay on Survival Following Coronary Surgery Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 345 - 350. [Abstract] [Full Text] [PDF]
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PREVENT IV Investigators Efficacy and Safety of Edifoligide, an E2F Transcription Factor Decoy, for Prevention of Vein Graft Failure Following Coronary Artery Bypass Graft Surgery: PREVENT IV: A Randomized Controlled Trial JAMA, November 16, 2005; 294(19): 2446 - 2454. [Abstract] [Full Text] [PDF]
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C. Rajakaruna, C.A. Rogers, G.D. Angelini, and R. Ascione Risk factors for and economic implications of prolonged ventilation after cardiac surgery J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1270 - 1277. [Abstract] [Full Text] [PDF]
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A. S. Cordeiro da Rocha, N. P. Rodrigues Dassa, F. J. Monassa Pittella, O. N. Barbosa, J. O. Reis Brito, B. Tura, and P. R. Dutra da Silva High Mortality Associated With Precluded Coronary Artery Bypass Surgery Caused by Severe Distal Coronary Artery Disease Circulation, August 30, 2005; 112(9_suppl): I-328 - I-331. [Abstract] [Full Text] [PDF]
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M. L. Williams, L. H. Muhlbaier, J. N. Schroder, J. A. Hata, E. D. Peterson, P. K. Smith, K. P. Landolfo, R. H. Messier, R. D. Davis, and C. A. Milano Risk-Adjusted Short- and Long-Term Outcomes for On-Pump Versus Off-Pump Coronary Artery Bypass Surgery Circulation, August 30, 2005; 112(9_suppl): I-366 - I-370. [Abstract] [Full Text] [PDF]
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P. W. Serruys, A. T.L. Ong, L. A. van Herwerden, J. E. Sousa, A. Jatene, J. J.R.M. Bonnier, J. P.M.A. Schonberger, N. Buller, R. Bonser, C. Disco, et al. Five-Year Outcomes After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease: The Final Analysis of the Arterial Revascularization Therapies Study (ARTS) Randomized Trial J. Am. Coll. Cardiol., August 16, 2005; 46(4): 575 - 581. [Abstract] [Full Text] [PDF]
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J. C.J. Sun, M. A. Crowther, T. E. Warkentin, A. Lamy, and K. H.T. Teoh Should Aspirin Be Discontinued Before Coronary Artery Bypass Surgery? Circulation, August 16, 2005; 112(7): e85 - e90. [Full Text] [PDF]
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C. W. Hogue Jr., L. L. Creswell, D. D. Gutterman, and L. A. Fleisher Epidemiology, Mechanisms, and Risks: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 9S - 16S. [Abstract] [Full Text] [PDF]
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