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Ann Thorac Surg 2003;75:74-81
© 2003 The Society of Thoracic Surgeons
a Department of Veterans Affairs Medical Center, Denver, Colorado, USA
b University of Colorado Health Sciences Center, Denver, Colorado, USA
c Office of Quality and Performance, Washington, D.C., USA
d Office of Patient Care Services, Department of Veterans Affairs Central Office, Washington, DC, USA
Accepted for publication August 1, 2002.
* Address reprint requests to Dr Shroyer, Cardiac Research, Department of Veterans Affairs Medical Center, 820 Clermont St (112R), Denver, CO 80220, USA.
e-mail: laurie.shroyer{at}med.va.gov
BACKGROUND: Differences in mortality risk factor sets during different time periods (eg, short-term versus intermediate-term) after coronary artery bypass grafting have been reported. However, little is known about the time-varying effects of mortality risk factors after the operation.
METHODS: We analyzed 11,815 veterans who had coronary artery bypass grafting at any of the 43 Veterans Affairs cardiac surgery centers from October 1997 to September 1999. Time-varying effects of 14 mortality risk factors during the 210 days after coronary artery bypass grafting were evaluated using Cox B-spline regression, which provides an estimate of risk for each variable for each day after operation.
RESULTS: Eight variables showed significant time-varying effects after operation. The effect of prior heart operation was very high immediately after operation, but disappeared within 1 week. Three other cardiac variables (prior myocardial infarction, preoperative intraaortic balloon pump, and Canadian Cardiovascular Society anginal class III or IV) also conferred the highest risk on the day of operation and decreased thereafter. In contrast, the four time-varying noncardiac risk variables (age, impaired functional status, chronic obstructive pulmonary disease, and renal dysfunction) showed little or no association with mortality immediately after operation, but had increasing impact during the several months after operation.
CONCLUSIONS: A sizable number of mortality risk factors have time-varying effects after coronary artery bypass grafting. Several cardiac risk factors have peak impact immediately after operation but dissipate thereafter. Several noncardiac risk factors confer little risk immediately after operation, but these risks increase during several months. This information may help clinicians focus management strategies for patients during the 7 months after operation.
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