HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MacKenzie, T. A. Search for Related Content PubMed Articles by MacKenzie, T. A. Related Collections Coronary disease Related Article

---

Original Articles: Adult Cardiac

Prediction of Survival After Coronary Revascularization: Modeling Short-Term, Mid-Term, and Long-Term Survival

^a Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
^b Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
^c Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Accepted for publication September 16, 2008.

^_* Address correspondence to Dr MacKenzie, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756 (Email: todd.a.mackenzie{at}hitchcock.org).

Background: Many clinical prediction rules for short-term mortality after coronary revascularization have been developed, validated, and introduced into routine clinical practice. Few rules exist for predicting long-term survival in the modern era of coronary revascularization. We report on the development and validation of models for predicting long-term survival after coronary artery bypass graft surgery and percutaneous coronary intervention on the basis of recent experience.

Methods: We linked 1987 through 2001 coronary artery bypass graft surgery and 1992 through 2001 percutaneous coronary intervention data from our northern New England registries on 35,000 patients with complete data on risk factors to the National Death Index, ascertaining 7,000 deaths. We partitioned time after revascularization into three periods on the basis of exploratory analysis using generalizations of Cox's semiparametric model to nonproportional hazards and nonlinear log-hazards. These periods were 0 to 3 months, 4 to 18 months, and 19 months and later. For each period, Cox's regression model was used to regress survival on risk factors yielding three models, which were then combined to make long-term predictions.

Results: These models were incorporated into easy-to-use software that yields predicted survival for up to 8 years after revascularization. The Harrell concordance statistic ranged from 72% to 83% for these models.

Conclusions: We developed and internally validated models that accurately predict long-term survival after coronary artery bypass graft surgery and percutaneous coronary intervention as currently performed. These models using routine clinical data, can be solved with available software, and could be used to enhance informed, patient-centered clinical decision making on the choice of revascularization procedure.

Related Article

Invited commentary.

and
Ann. Thorac. Surg. 87: 473-474. [Full Text]

This article has been cited by other articles:

				A. L. W. Shroyer and G. K. Grunwald Invited commentary. Ann. Thorac. Surg., February 1, 2009; 87(2): 473 - 474. [Full Text] [PDF]