Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group

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Circulation. 1992;85:2110-2118

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ARTICLES

Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group

GT O'Connor, SK Plume, EM Olmstead, LH Coffin, JR Morton, CT Maloney, ER Nowicki, DG Levy, JF Tryzelaar and F Hernandez
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.

BACKGROUND. A prospective regional study was conducted to identify factors associated with in-hospital mortality among patients undergoing isolated coronary artery bypass graft surgery (CABG). A prediction rule was developed and validated based on the data collected. METHODS AND RESULTS. Data from 3,055 patients were collected from five clinical centers between July 1, 1987, and April 15, 1989. Logistic regression analysis was used to predict the risk of in-hospital mortality. A prediction rule was developed on a training set of data and validated on an independent test set. The metric used to assess the performance of the prediction rule was the area under the relative operating characteristic (ROC) curve. Variables used to construct the regression model of in-hospital mortality included age, sex, body surface area, presence of comorbid disease, history of CABG, left ventricular end- diastolic pressure, ejection fraction score, and priority of surgery. The model significantly predicted the occurrence of in-hospital mortality. The area under the ROC curve obtained from the training set of data was 0.74 (perfect, 1.0). The prediction rule performed well when used on a test set of data (area, 0.76). The correlation between observed and expected numbers of deaths was 0.99. CONCLUSIONS. The prediction rule described in this report was developed using regional data, uses only eight variables, has good performance characteristics, and is easily available to clinicians with access to a microcomputer or programmable calculator. This validated multivariate prediction rule would be useful both to calculate the risk of mortality for an individual patient and to contrast observed and expected mortality rates for an institution or a particular clinician.

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				D. Jegger, J.-P. Revelly, J. Horisberger, L. K. von Segesser, and P. Ruchat Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery Perfusion, September 1, 2007; 22(5): 311 - 316. [Abstract] [PDF]

				C. Simon, R. Luciani, F. Capuano, A. Miceli, A. Roscitano, E. Tonelli, and R. Sinatra Mild and moderate renal dysfunction: impact on short-term outcome Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 286 - 290. [Abstract] [Full Text] [PDF]

				G. Ambler, R. Z Omar, and P. Royston A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome Statistical Methods in Medical Research, June 1, 2007; 16(3): 277 - 298. [Abstract] [PDF]

				D. M. Charytan and R. E. Kuntz Risks of coronary artery bypass surgery in dialysis-dependent patients--analysis of the 2001 National Inpatient Sample Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1665 - 1671. [Abstract] [Full Text] [PDF]

				A. S. Adabag, T. Rector, S. Mithani, J. Harmala, H. B. Ward, R. F. Kelly, J. T. Nguyen, E. O. McFalls, and H. E. Bloomfield Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery Ann. Thorac. Surg., May 1, 2007; 83(5): 1744 - 1750. [Abstract] [Full Text] [PDF]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

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				D. S. Likosky, W. C. Nugent, R. A. Clough, P. W. Weldner, H. B. Quinton, C. S. Ross, and G. T. O'Connor Comparison of Three Measurements of Cardiac Surgery Mortality for the Northern New England Cardiovascular Disease Study Group Ann. Thorac. Surg., April 1, 2006; 81(4): 1393 - 1395. [Abstract] [Full Text] [PDF]

				M. Berman, A. Stamler, G. Sahar, G. P. Georghiou, E. Sharoni, R. Brauner, B. Medalion, B. A. Vidne, and A. Kogan Validation of the 2000 Bernstein-Parsonnet Score Versus the EuroSCORE as a Prognostic Tool in Cardiac Surgery Ann. Thorac. Surg., February 1, 2006; 81(2): 537 - 540. [Abstract] [Full Text] [PDF]

				R. V.H.P. Huijskes, R. M.J. Wesselink, L. Noyez, P. M.J. Rosseel, T. Klok, B. H.M. van Straten, A. Nesselaar, and J. G.P. Tijssen Predictive models for thoracic aorta surgery. Is the Euroscore the optimal risk model in the Netherlands? Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 538 - 542. [Abstract] [Full Text] [PDF]

				M. J. Holzmann, S. Ahnve, N. Hammar, L. Jorgensen, K. Klerdal, K. Pehrsson, and T. Ivert Creatinine clearance and risk of early mortality in patients undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 746 - 746. [Abstract] [Full Text] [PDF]

				A. Garland Improving the ICU: Part 1 Chest, June 1, 2005; 127(6): 2151 - 2164. [Abstract] [Full Text] [PDF]

				L. J. Dacey, D. S. Likosky, B. J. Leavitt, S. J. Lahey, R. D. Quinn, F. Hernandez Jr, H. B. Quinton, J. P. Desimone, C. S. Ross, G. T. O'Connor, et al. Perioperative Stroke and Long-Term Survival After Coronary Bypass Graft Surgery Ann. Thorac. Surg., February 1, 2005; 79(2): 532 - 536. [Abstract] [Full Text] [PDF]

				R. C. Arora, J.-F. Legare, K. J. Buth, J. A. Sullivan, and G. M. Hirsch Identifying Patients at Risk of Intraoperative and Postoperative Transfusion in Isolated CABG: Toward Selective Conservation Strategies Ann. Thorac. Surg., November 1, 2004; 78(5): 1547 - 1554. [Abstract] [Full Text] [PDF]

				D. M. Shahian, E. H. Blackstone, F. H. Edwards, F. L. Grover, G. L. Grunkemeier, D. C. Naftel, S. A.M. Nashef, W. C. Nugent, and E. D. Peterson Cardiac Surgery Risk Models: A Position Article Ann. Thorac. Surg., November 1, 2004; 78(5): 1868 - 1877. [Abstract] [Full Text] [PDF]

				R. Kettelkamp, J. House, M. Garg, R. S. Stuart, A. Grantham, and J. Spertus Using the Risk of Restenosis as a Guide to Triaging Patients Between Surgical and Percutaneous Coronary Revascularization Circulation, September 14, 2004; 110(11_suppl_1): II-50 - II-54. [Abstract] [Full Text] [PDF]

				S. A M Nashef and R. J F Baskett Quality Assessment in Cardiac Surgery: Do Not Miss the Boat! Asian Cardiovasc Thorac Ann, September 1, 2004; 12(3): 187 - 189. [Full Text] [PDF]

				D. J. O'Rourke, H. B. Quinton, W. Piper, F. Hernandez, J. Morton, B. Hettleman, M. Hearne, W. Nugent, G. T. O'Connor, and D. J. Malenka Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery Ann. Thorac. Surg., August 1, 2004; 78(2): 466 - 470. [Abstract] [Full Text] [PDF]

				E. R. Nowicki, N. J. O. Birkmeyer, R. W. Weintraub, B. J. Leavitt, J. H. Sanders, L. J. Dacey, R. A. Clough, R. D. Quinn, D. C. Charlesworth, D. A. Sisto, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England Ann. Thorac. Surg., June 1, 2004; 77(6): 1966 - 1977. [Abstract] [Full Text] [PDF]

				R. Z. Omar, G. Ambler, P. Royston, J. Eliahoo, and K. M. Taylor Cardiac surgery risk modeling for mortality: a review of current practice and suggestions for improvement Ann. Thorac. Surg., June 1, 2004; 77(6): 2232 - 2237. [Abstract] [Full Text] [PDF]

				R. C Groom, A. J Rassias, J. E Cormack, G. R DeFoe, C. DioDato, C. K Krumholz, R. J Forest, J. W Pieroni, B. O'Connor, C. S Warren, et al. Highest core temperature during cardiopulmonary bypass and rate of mediastinitis Perfusion, March 1, 2004; 19(2): 119 - 125. [Abstract] [PDF]