Effect of bypass surgery on survival in patients in low- and high-risk subgroups delineated by the use of simple clinical variables

Circulation
K M DetreT Takaro

Abstract

A multivariate risk function was developed on data from all 508 medical patients in the Veterans Administration (VA) randomized study of coronary bypass surgery. The variables, in order of importance, were ST-segment depression on resting ECG, history of myocardial infarction, history of hypertension and New York Heart Association functional classification III or IV. These noninvasive variables have been reported to be risk factors in natural-history studies of coronary heart disease (CHD). Applying the risk function to medical and surgical patients of the 1972-1974 cohort yielded a 5-year probability of dying for each patient. Investigation of treatment effects in approximate terciles obtained by collapsing the probability distribution into low-, middle- and high-risk groups showed that surgery was beneficial for patients in the high-risk tercile even after removal of patients with left main coronary artery disease (17% surgical vs 34% medical mortality at 5 years; p less than 0.01). This finding was accentuated when patients in the 10 hospitals with the lowest operative mortality (3.3%) were compared. Mortality results in the low-risk tercile favored medical treatment (medical vs surgical mortality 7% vs 17%; p less than 0.05...Continue Reading

References

Jan 1, 1978·Cleveland Clinic Quarterly·A Oberman, J C Baldone
Jul 1, 1968·Journal of Chronic Diseases·E WeinblattR V Sager

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Citations

Nov 30, 1991·Lancet·D L Patterson, T Treasure
Jan 1, 1988·Journal of the American College of Cardiology·R M CaliffD B Pryor
Sep 1, 1989·Journal of the American College of Cardiology·M A Hlatky, H P Selker
Jul 1, 1986·The Annals of Thoracic Surgery·G C Kaiser
Oct 18, 2003·Journal of the American College of Cardiology·Timothy A SanbornUNKNOWN SHOCK Investigators
Oct 1, 1986·Journal of the American College of Cardiology·G D Plotnick
Apr 8, 1998·Journal of the American College of Cardiology·R G Favaloro
Jun 27, 1985·The New England Journal of Medicine·E PassamaniT Killip
Jul 25, 1996·The New England Journal of Medicine·UNKNOWN Bypass Angioplasty Revascularization Investigation (BARI) Investigators
Aug 1, 1995·Australian and New Zealand Journal of Medicine·C J EllisA R Kerr
Oct 1, 1985·British Heart Journal·D G Julian
Nov 26, 2011·BMC Health Services Research·Fiona M ClementUNKNOWN APPROACH Investigators
Jan 10, 2012·Annual Review of Public Health·Harold C Sox, Steven N Goodman
Dec 1, 1982·Controlled Clinical Trials·K Detre, P Peduzzi
Oct 1, 1982·Chest·H S Hecht, S H Rahimtoola
Nov 1, 1984·The American Journal of Cardiology·H N Hultgren, P Peduzzi
Dec 1, 1985·Disease-a-month : DM·H C Sox
Jul 1, 1987·Progress in Cardiovascular Diseases·R L FryeM B Mock
Jan 1, 1983·Progress in Cardiovascular Diseases·K E Hammermeister
Jul 4, 2006·The American Journal of Cardiology·Gregory W BarsnessUNKNOWN BARI 2D Trial Investigators
Aug 1, 1982·Australian and New Zealand Journal of Medicine·Z Freeman, A Freeman
Oct 19, 2005·Current Problems in Cardiology·Gregory W BarsnessBernard J Gersh
Feb 1, 1983·The American Journal of Cardiology·L GoldmanE F Cook
Oct 1, 1982·The American Journal of Cardiology·H N HultgrenD C Miller
Dec 31, 1997·The American Journal of Cardiology·B J Gersh

❮ Previous
Next ❯