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Ann Thorac Surg 2000;70:1759-1760
© 2000 The Society of Thoracic Surgeons
a Cardiac Surgical Associates, P.A., 920 East 28th, Minneapolis, MN 55407, USA,
e-mail: karom{at}csa-heart.com
To the Editor
We have read and are responding to the letter by Drs Weinstein and Janosky in which they challenge the statistical analysis and the follow-up results as presented in Table 3 of the article titled, "Safety and efficacy of off-pump coronary artery bypass grafting" (Ann Thorac Surg 2000;69:704–10). After careful review and recalculation of the data presented in the article, our response to their questions follows.
In the published manuscript on page 706, in the section titled "Follow-up Results," it states that: "Follow-up was completed in 3,077 patients at the end of 1 year (28,587 patient months). One hundred sixty-eight total patients died (119 operative deaths and 49 late deaths), and 276 total patients were lost to follow-up resulting in 66% 1-year complete follow-up." The denominators that Drs Weinstein and Janosky used (2,576 low-risk CCAB, 688 medium-risk CCAB, 123 high-risk CCAB, and 216 low risk OPCAB, 95 medium risk OPCAB, and 39 high risk OPCAB) are incorrect. These figures represent the total number of patients in each group and are not reflective of those patients available and eligible for 1-year follow-up as stated in the manuscript and table. They neglected to subtract mortalities lost to follow-up patients and those patients who had not yet reached the 1-year follow-up period and those who had incomplete surveys. It is stated in the follow-up section that only 66% of the patients met the criteria. Drs Weinstein and Janosky also calculated rates for "readmission" and the manuscript does not report that variable.
The method applied for assessing statistical significance was with the 
2 or Fisher’s exact test depending upon patient population size. All values on page 708, Table 3, were recalculated by an independent source and found to be correct. Our application and results of the statistical analysis is appropriate and correct.
Doctors Weinstein and Janosky are correct to state that just because a statistically significant value is not obtained does not imply that there is no difference. In the "Conclusion" section, we reference the concerning trend that OPCAB patients are returning more frequently for reintervention and or anginal events than the CCAB patients. We do not believe that this represents a serious inferior result with OPCAB, but it certainly is a trend to be monitored and studied through angiographic comparison. We have also stated that those patients who required reintervention were not investigated for location and severity of a progressive disease state, which would have answered the question of new native disease progression, incomplete revascularization, or technical limitations of the procedure.
We thank Drs Weinstein and Janosky for they comment. Their challenge assures us that the scientific peer review process is working.
Related Article
Ann. Thorac. Surg. 2000 70: 1758-1759.
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