| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
European Journal of Cardio-Thoracic Surgery, Vol 11, 2-9, Copyright © 1997 by European Association for Cardio-thoracic Surgery
P Sergeant, E Blackstone and B Meyns
OBJECTIVE: To test prospectively the unsubstantiated claim that patient-
specific predictions of time-related outcome after coronary artery bypass
grafting (CABG) from multivariable parametric equations are reliable for
medical decision making and for intra- and interdepartmental quality
control in surgical training and practice. METHODS: 3720 survival curves
were generated prospectively for all primary, isolated CABG patients
operated upon at the Katholieke Universiteit (KU) Leuven between July, 1987
and January, 1992 using the published AHA/ACC guidelines multivariable
equation derived from prior KU Leuven experience. The average of these
curves (risk-adjusted predicted survival) was compared to the Kaplan-Meier
(actual) estimates, overall and for patient subsets. Variables associated
with systematic deviation of actual from predicted number of deaths were
sought by multivariable residual risk analysis. RESULTS: Actual overall
survival was less good than predicted (P = 0.03) and the excess risk was
distributed uniformly across time. The excess risk was not attributable to
substantial changes in prevalence of known risk factors. It was
attributable largely to a small subset of patients (n = 292) with
low-prevalence, but important risk factors not accounted for by the
equation (P = 0.7, for difference in survival among the remaining 3428
patients). CONCLUSIONS: Within the confines of a single institution,
patient-specific predictions of outcome after CABG can be made reliably in
most patients using multivariable equations developed from a heterogeneous
experience, despite changes in prevalence of risk factors. New subsets of
high-risk patients, failure or inability to account for important rare risk
factors or for institutional changes, may lead to systematic errors of
prediction. Under these limitations it is an excellent tool for medical
decision making and audit of surgical training and practice.
ARTICLES
Can the outcome of coronary bypass grafting be predicted reliably?
Cardiac Surgery Department, Gasthuisberg University Hospital, Leuven, Belgium. Paul.Sergeant@med.kuleuven.ac.be
This article has been cited by other articles:
|
|
 |
|
  B. R. Osswald, V. Gegouskov, D. Badowski-Zyla, U. Tochtermann, G. Thomas, S. Hagl, and E. H. Blackstone Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement Eur. Heart J., January 1, 2009; 30(1): 74 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Thromboembolism after pneumonectomy for malignancy: An independent marker of poor outcome. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 711 - 718.
|
|
|
|
 |
|
 G Leandro, N Rolando, G Gallus, K Rolles, and A K Burroughs Monitoring surgical and medical outcomes: the Bernoulli cumulative SUM chart. A novel application to assess clinical interventions Postgrad. Med. J., October 1, 2005; 81(960): 647 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. H. Blackstone Monitoring surgical performance J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 807 - 810. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Quader, P. M. McCarthy, A. M. Gillinov, J. M. Alster, D. M. Cosgrove III, B. W. Lytle, and E. H. Blackstone Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Ann. Thorac. Surg., May 1, 2004; 77(5): 1514 - 1524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Asimakopoulos, S. Al-Ruzzeh, G. Ambler, R.Z. Omar, P. Punjabi, M. Amrani, and K.M. Taylor An evaluation of existing risk stratification models as a tool for comparison of surgical performances for coronary artery bypass grafting between institutions Eur. J. Cardiothorac. Surg., June 1, 2003; 23(6): 935 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. W. Rice, E. H. Blackstone, L. A. Rybicki, D. J. Adelstein, S. C. Murthy, M. M. DeCamp, and J. R. Goldblum Refining esophageal cancer staging J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1103 - 1113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.T. van Domburg, J.J.M. Takkenberg, L.A. van Herwerden, A.C. Venema, and A.J.J.C. Bogers Short-term and 5-year outcome after primary isolated coronary artery bypass graft surgery: results of risk stratification in a bilocation center Eur. J. Cardiothorac. Surg., April 1, 2002; 21(4): 733 - 740. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sergeant, E. de Worm, and B. Meyns Single centre, single domain validation of the EuroSCORE on a consecutive sample of primary and repeat CABG Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1176 - 1182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Zurbrugg, F. Knollmann, M. Musci, M. Wied, M. Bauer, T. Chavez, A. Krukenberg, and R. Hetzer The biocompound method in coronary artery bypass operations: surgical technique and 3-year patency Ann. Thorac. Surg., November 1, 2000; 70(5): 1536 - 1540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Graham, R. J. Chambers, and R. F. Davies ANGIOGRAPHIC QUANTIFICATION OF DIFFUSE CORONARY ARTERY DISEASE: RELIABILITY AND PROGNOSTIC VALUE FOR BYPASS OPERATIONS J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 618 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. T. Sergeant and E. H. Blackstone Closing the loop: optimizing physicians’ operational and strategic behavior Ann. Thorac. Surg., August 1, 1999; 68(2): 362 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sergeant, E. Blackstone, and B. Meyns Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important? J. Thorac. Cardiovasc. Surg., September 1, 1998; 116(3): 440 - 444. [Abstract] [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
