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

This Article Abstract 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 Similar articles in PubMed 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 Disch, D. L. Search for Related Content PubMed PubMed Citation Articles by Disch, D. L.

Ann Thorac Surg 1994;57:416-423
© 1994 The Society of Thoracic Surgeons

---

Articles

Changes in patients undergoing coronary artery bypass grafting: 1987–1990

^a Departments of Medicine, Surgery, abd Community and Family Medicine, the Program in Medical Information Science, and the Center for Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
^b The US Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA

Accepted for publication April 9, 1993.

^_* Address reprint requests to Dr O'Connor, Department of Medicine, Clinical Research Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.

	Abstract

Top Abstract Footnotes References

 
A prospective study of 7,590 consecutive patients undergoing isolated coronary artery bypass grafting at five medical centers in Maine, New Hampshire, and Vermont between July 1987 and December 1990 assessed changes in patient characteristics over time. Variables included age, sex, surgical priority, ejection fraction, left ventricular end-diastolic pressure, and left main coronary artery stenosis of 90% or greater. Trends were assessed for each variable and for predicted mortality using linear regression. The mean age increased significantly, whereas ejection fraction decreased. The percentage of urgent cases increased, whereas the elective cases became less frequent. No changes were observed in the percentages of emergent cases, female patients, or patients with severe left main coronary artery disease. The predicted in-hospital mortality rose significantly from 4.2% to 5.2% (p < 0.001). The increase in urgent surgical intervention was the most substantial contributor. Subgroup analyses did not support a systematic misclassification of elective patients into the urgent group. This study demonstrates that the characteristics of the cohort of patients undergoing coronary artery bypass grafting changed substantially from 1967 to 1990. These changes should be considered when interpreting surgical outcomes.

	Footnotes

Top Abstract Footnotes References

 
This work is also supported in part by the Merck/Society for Epidemiologic Research Clinical Epidemiology Fellowship and a First award (LM 04667) to Dr O'Connor, and by grants from the AHCPR (HS 06503 and HS 06813).

¹ Dr Disch is supported by the VA Fellowship in Ambulatory Care.

	References

Top Abstract Footnotes References

 

1. Rahimtoola SH, Grunkemeier GL, Teply JF, et al. Changes in coronary artery bypass surgery leading to improved survival JAMA 1981;246:1912-1916.[Medline]
2. Cosgrove DM, Loop FD, Sheldon WC. Results of myocardial revascularization: a 12-year experience Circulation 1982;65(Suppl 2):37-43.[Abstract]
3. Loop FD, Cosgrove DM, Lytle BW, et al. An 11 year evolution of coronary arterial surgery (1967–1978) Ann Surg 1979;190:444-455.[Medline]
4. Miller DC, Stinson EB, Oyer PE, et al. Discriminant analysis of the changing risks of coronary artery operations: 1971–1979 J Thorac Cardiovasc Surg 1983;85:197-213.[Abstract]
5. Naunheim KS, Fiore AC, Wadley JJ, et al. The changing profile of the patient undergoing coronary artery bypass surgery J Am Coll Cardiol 1988;11:494-498.[Medline]
6. Davis PK, Parascandola SA, Miller CA, et al. Mortality of coronary artery bypass grafting before and after the advent of angioplasty Ann Thorac Surg 1989;47:493-498.[Abstract/Free Full Text]
7. Weintraub WS, Jones EL, King SB, et al. Changing use of coronary angioplasty and coronary bypass surgery in the treatment of chronic coronary artery disease Am J Cardiol 1990;65:183-188.[Medline]
8. Christakis GT, Ivanov J, Weisel RD, Birnbaum PL, David TE, Salerno TA. The changing pattern of coronary artery bypass surgery Circulation 1989;80(Suppl 1):151-161.
9. Cosgrove DM, Loop FD, Lytle BW, et al. Primary myocardial revascularization: trends in surgical mortality J Thorac Cardiovasc Surg 1984;88:673-684.[Abstract]
10. Arcidi JM, Powelson SW, King SB, et al. Trends in invasive treatment of single-vessel and double-vessel coronary disease J Thorac Cardiovasc Surg 1988;95:773-781.[Abstract]
11. O'Connor GT, Plume SK, Olmstead EM, et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery Circulation 1992;85:2110-2118.[Abstract/Free Full Text]
12. Charlson ME, Pompei P, Ales KI, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation J Chronic Dis 1987;40:373-383.[Medline]
13. Roos NP, Wennberg JE, Malenka DJ, et al. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia N Engl J Med 1989;320:1120-1124.[Medline]
14. Roos LL, Roos NP. Large databases and research on surgeryIn: Rutkow I, editor. Socioeconomics of surgery. St. Louis: Mosby-Year Book; 1989. pp. 258-275.
15. O'Connor GT, Plume SK, Olmstead EM, et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting JAMA 1991;266:803-809.[Medline]
16. Jones EL, Weintraub WS, Craver JM, Guyton RA, Cohen CL. Coronary bypass surgery: is the operation different today? J Thorac Cardiovasc Surg 1991;101:108-115.[Abstract]
17. Teoh KH, Christakis GT, Weisel RD, Katz AM, et al. Increased risk of urgent revascularization J Thorac Cardiovasc Surg 1987;93:291-299.[Abstract]
18. Christakis GT, Fremes SE, Weisel RD, et al. Reducing the risk of urgent revascularization for unstable angina: a randomized clinical trial J Vase Surg 1986;3:764-772.
19. Hammermeister KE, Burchfiel C, Johnson R, Grover FL. Identification of patients at greatest risk for developing major complications at cardiac surgery Circulation 1990;82(Suppl IV)IV-380-9.
20. Kennedy JW, Kaiser GC, Fisher LD, et al. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery J Thorac Cardiovasc Surg 1980;80:876-887.[Abstract]
21. Junod FL, Harlan BJ, Payne J, et al. Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results Ann Thorac Surg 1987;43:59-64.[Abstract/Free Full Text]
22. Higgins TL, Estafanous FC, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients JAMA 1992;267:2344-2348.[Medline]

This article has been cited by other articles:

				M. D. Pierri, F. Capestro, C. Zingaro, and L. Torracca The changing face of cardiac surgery patients: an insight into a Mediterranean region Eur J Cardiothorac Surg, October 1, 2010; 38(4): 407 - 413. [Abstract] [Full Text] [PDF]

				A. Jonsson, N. Hammar, T. Nordquist, and T. Ivert Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery -- an experience covering three decades Eur J Cardiothorac Surg, August 1, 2006; 30(2): 311 - 317. [Abstract] [Full Text] [PDF]

				F. Onorati, M. D. Feo, P. Mastroroberto, A. d. Virgilio, A. Esposito, M. Polistena, A. Renzulli, and M. Cotrufo Unstable angina and non-ST segment elevation: surgical revascularization with different strategies Eur J Cardiothorac Surg, June 1, 2005; 27(6): 1043 - 1050. [Abstract] [Full Text] [PDF]

				M S T Hobbs, K A McCaul, M W Knuiman, J M Rankin, and I Gilfillan Trends in coronary artery revascularisation procedures in Western Australia, 1980-2001 Heart, September 1, 2004; 90(9): 1036 - 1041. [Abstract] [Full Text] [PDF]

				S. W. Boyce, C. Bartels, R. Bolli, B. Chaitman, J. C. Chen, E. Chi, A. Jessel, D. Kereiakes, J. Knight, L. Thulin, et al. Impact of sodium-hydrogen exchange inhibition by cariporide on death or myocardial infarction in high-risk CABG surgery patients: results of the CABG surgery cohort of the GUARDIAN study J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 420 - 427. [Abstract] [Full Text] [PDF]

				F. Hernandez, W. E. Cohn, Y. R. Baribeau, J. F. Tryzelaar, D. C. Charlesworth, R. A. Clough, J. D. Klemperer, J. R. Morton, B. M. Westbrook, E. M. Olmstead, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience Ann. Thorac. Surg., November 1, 2001; 72(5): 1528 - 1534. [Abstract] [Full Text] [PDF]

				S. K. Plume, G. T. O'Connor, and E. M. Olmstead Update 2000: Changes in patients undergoing coronary artery bypass grafting: 1987-1990 Ann. Thorac. Surg., July 1, 2001; 72(1): 314 - 315. [Abstract] [Full Text] [PDF]

				D. J. O'Rourke, D. J. Malenka, E. M. Olmstead, H. B. Quinton, J. H. Sanders Jr, S. J. Lahey, M. Norotsky, R. D. Quinn, Y. R. Baribeau, F. Hernandez Jr, et al. Improved in-hospital mortality in women undergoing coronary artery bypass grafting Ann. Thorac. Surg., February 1, 2001; 71(2): 507 - 511. [Abstract] [Full Text] [PDF]

				R. Sadanandam, N. Al Khaja, M. A. Aziz, and M. A. Turner Profile of Coronary Artery Bypass Surgery in United Arab Emirates: Dubai Hospital Experience Asian Cardiovascular and Thoracic Annals, June 1, 1998; 6(2): 118 - 124. [Abstract] [Full Text] [PDF]

				F. G. Estafanous, F. D. Loop, T. L. Higgins, S. Tekyi-Mensah, B. W. Lytle, D. M. Cosgrove Jr, and N. J. Starr Increased Risk and Decreased Morbidity of Coronary Artery Bypass Grafting Between 1986 and 1994 Ann. Thorac. Surg., February 1, 1998; 65(2): 383 - 389. [Abstract] [Full Text] [PDF]

				R. W. Emery, N. L. Mills, F. J. Teijeira, K. V. Arom, P. Baldwin, R. J. Petersen, L. D. Joyce, G. L. B. Grinnan, M. S. Sussman, J. G. Copeland III, et al. North American Experience With the Perma-Flow Prosthetic Coronary Graft Ann. Thorac. Surg., September 1, 1996; 62(3): 691 - 695. [Abstract] [Full Text]

				H. C. Alhan, H. Karabulut, R. Tosun, F. Karakoc, I. Okar, E. Demiray, S. Tarcan, and B. Yigiter Intermittent Aortic Cross-Clamping and Cold Crystalloid Cardioplegia for Low-Risk Coronary Patients Ann. Thorac. Surg., March 1, 1996; 61(3): 834 - 839. [Abstract] [Full Text]

				G. Paone, R. S.D. Higgins, T. Spencer, and N. A. Silverman Enrollment in the Health Alliance Plan HMO Is Not an Independent Risk Factor for Coronary Artery Bypass Graft Surgery Circulation, November 1, 1995; 92(9): 69 - 72. [Abstract] [Full Text]

				Y. A. G. Louagie, J. Jamart, M. Buche, P. M. Eucher, D. Schoevaerdts, E. Collard, M. Gonzalez, B. Marchandise, and J.-C. Schoevaerdts Operation for unstable angina pectoris: Factors influencing adverse in-hospital outcome Ann. Thorac. Surg., May 1, 1995; 59(5): 1141 - 1149. [Abstract] [PDF]

				J. Daley Criteria by which to evaluate risk-adjusted outcomes programs in cardiac surgery Ann. Thorac. Surg., December 1, 1994; 58(6): 1827 - 1835. [Abstract] [PDF]

This Article Abstract 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 Similar articles in PubMed 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 Disch, D. L. Search for Related Content PubMed PubMed Citation Articles by Disch, D. L.