АКШ

Data Supplement 24. Management of Hyperlipidemia

Study Name

Aim of

Study

Study

Patient Population/Inclusion &

Endpoints

Statistical

P-Values &

OR / HR /

Study Summary

Study

Other

Study

Type

Size

Exclusion Criteria

Analysis

95% CI

RR

Limitations

Informa

Reported

tion

Inclusion

Exclusion Criteria

Primary Endpoint

Secondary

Criteria

Endpoint OR/HR:

(95% CI)

The Post

To compare

RCT

1,192

1) Patients 1 to

1) Likelihood of

Percent of grafts

Lipid lowering:

Intention-

p<0.001

N/A

Reduced rate of

Not powered to

Mean

Coronary

2 strategies

11 y post-

revascularization/deat

with angiographic

mean 93 to 97

to-treat

SVG

detect

follow-

Artery

of lipid-

CABG;

h within 5 y; 2)

evidence of

mg/dL (intensive)

atherosclerotic

difference in

up 4.3 y

Bypass Graft

lowering

2) Baseline

UA/MI within 6 mo;

atherosclerotic

vs. 132 to 136

progression with

clinical events

Trial

and their

LDL 130 to 175

3) Severe angina; 4)

progression: 27%

mg/dL

intensive lipid-

Investigators.

effect on

mg/dL 3) ≤1

HF; 5)

(intensive) vs. 39%

(moderate)

lowering (statin)

1997 (170)

bypass graft

patent vein

Contraindication to

(moderate)

therapy

disease

graft on

prescription with

baseline

medication

angiogram

Rate of repeat

p=0.03

revascularization:

6.5% (intensive)

vs. 9.2%

(moderate)

Dotani 2000

To examine

Retrosp

323

Consecutive

None

60 d

None

N/A

p<0.001

OR: 0.28

N/A

N/A

N/A

(171)

effect of

ective

patients

death/MI/recurrent

preoperativ

case-

admitted for

angina: 9%

e statins on

control

CABG over 10

(nonstatin) vs. 1%

60 d and 1 y

mo period in

(statin)

post-CABG

1997

outcomes

60 d any adverse

p<0.0001

OR: 0.31

outcome (death,

MI, UA, CHF,

arrhythmia, CVA):

37% (nonstatin) vs.

15% (statin use)

© American College of Cardiology Foundation and American Heart Association, Inc.

1 y any adverse

p<0.001

OR: 0.26

Preoperative statin

Nonrandomized

outcome: 45%

therapy associated

, retrospective

(nonstatin) vs. 18%

with reduced CV

(may be

(statin)

events at 60 d and

unmeasured

1 y

factors that

account for

difference

between statin

and nonstatin

outcomes)

Pan 2004 (172)

To examine

Retrosp

1,663

Consecutive

N/A

N/A

N/A

30 d all

p<0.05; 95%

OR: 0.53

Preoperative statin

Nonrandomized

Confirm

effect of

ective

patients

cause

CI: 0.28 to

therapy may

, retrospective

ed in a

statin

case-

undergoing

mortality:

0.99

reduce early

(may be

propensit

therapy on

control

CABG at single

3.75%

mortality of

unmeasured

y-

perioperativ

institution from

(nonstatin)

CABG

factors that

matched

e CABG

2000 to 2001

vs. 1.8%

account for

cohort of

mortality

(preoperati

difference

1,362

ve statin)

between statin

patients

and nonstatin

outcomes)

Collard 2006

To assess

Retrosp

2,663

Patients

N/A

Risk of early

No difference in

N/A

p<0.03;

OR: 0.25;

Preoperative statin

Retrospective,

Postoper

(173)

preoperativ

ective

undergoing

cardiac death post-

postoperative

95% CI: 0.07

for early

use is associated

nonrandomized

ative

e statin

case-

CABG in 70

CABG: 0.3%

nonfatal, in-

to 0.87

cardiac

with reduced

statin

therapy on

control

centers/17

(statin-treated) vs.

hospital MI

death

cardiac mortality

discontin

postoperativ

countries from

1.4% (not-statin

after CABG

uation

e

1996 to 2000

treated)

associate

mortality/M

d with

I

increased

in-

hospital

mortality

: 1.9%

(disconti

nued) vs.

0.5%

(continue

d) (OR:

2.95 for

death;

95% CI:

© American College of Cardiology Foundation and American Heart Association, Inc.

1.31 to

6.66;

p<0.01)

Clark 2006 (174)

To assess

Retrosp

3,113

Consecutive

N/A

30 d

N/A

N/A

p<0.05

N/A

Preoperative statin

Nonrandomized

N/A

statin

ective

with

cardiac surgery

mortality/morbidit

use confers a

, retrospective

therapy on

case-

CABG

patients over 8

y (risk-adjusted):

"protective effect"

postoperativ

control

± valve

y period

mortality OR:

with regard to

e surgical

0.55; (95% CI:

postoperative

outcomes

0.32 to 0.93);

outcomes

(included

morbidity OR:

CABG

0.76 (95% CI: 0.62

alone, valve

to 0.94) favoring

alone or

statin users

combined)

Kulik 2008 (175)

To assess

Retrosp

7,503

Medicare

N/A

All cause mortality

MACE HR: 0.89;

Intention-

N/A

N/A

Postoperative

Nonrandomized

N/A

early

ective

patients

(median follow-up

(95% CI: 0.81 to

to-treat

statin use within 1

, retrospective

postoperativ

case-

undergoing

4 y) HR: 0.82

0.98); p=0.02

mo of discharge

e statin use

control

CABG from

favoring statin

reduces all-cause

vs. no early

1995 to 2003

users within 1 m

mortality and

postoperativ

(95% CI: 0.72 to

MACE following

e statin use

0.94); p=0.004

CABG

and post-

CABG

outcome

CABG indicates coronary artery bypass graft; CHF, congestive heart failure; CI, confidence interval; CVA, cerebral vascular accident; CV, cardiovascular; d, day; HF, heart failure; HR, hazard ratio; LDL, low-density lipoprotein; m, month; MACE, major adverse cardiac events; MI, myocardial infarction; N/A, not applicable; OR, odds ratio; RR, relative risk; SVG, saphenous vein graft; UA, unstable angina; and y, year.

Data Supplement 25. Beta Blockers

Author (Trial)	Drug	Number of	AF Episode	RR (95%	ARR (95% CI)	P-Value	Comments
		Patients	(Percent)	CI)
Halonen et al.2006 (176)	IV metoprolol administration (1	119	20 (17%)	0.4 (0 .02	0.11 (0.01 to 0.22)	p=0.04	Dosing started on the first postoperative morning;
	to 3 mg/h)			to 0.63)			Continued for 48 h; No difference in onset of AF
							in h after surgery (26.5 h IV vs. 30.1 h oral); IV
							metoprolol temporarily discontinued for ≥1 h due
							to hypotension or bradycardia in 15.1%

© American College of Cardiology Foundation and American Heart Association, Inc.

Halonen et al. 2006 (176)	Oral metoprolol administration	121	34 (28%)
	(25 mg bid up to 50 mg bid
	titrated to heart rate)

AF indicates atrial fibrillation; ARR, absolute risk reduction; bid, twice daily; IV, intravenous; mg, milligram; and RR, relative risk.

Data Supplement 26. ACE Inhibitors: Table 1

Author

Definition

Inclusion

Exclusion

Statistical

Primary Outcome

Secondary Outcomes

Primary Results OR (95%

Secondary Results

Methods

CI); P-Value

[OR (95% CI); P-Value]

Miceli et al.

Use of ACE

10,023 isolated

Unknown ACE

Propensity

30 d mortality, overall

Renal dysfunction, AF, MI,

OR: 2.0 (1.2 to 3.4); p=0.01,

Renal dysfunction OR 1.4; (1.1

2009 (177)

inhibitors within

CABG, single

inhibitor status,

matching 3,052

rate 1%

stroke, inotrope use

ACE inhibitor vs. Non-ACE

to 1.7); p=0.006

24 h of surgery

site, 1996 to

preoperative shock

patients per group,

inhibitor

AF: OR: 1.3; 1.2 to 1.5;

2008

OPCAB 49%

p<0.0001

Inotrope: OR: 1.2 (1.1 to 1.4);

p<0.0001

No difference in MI or stroke

Rader et al.

Use of ACE or

10,552 CABG ±

Preoperative AF or

Propensity

Postoperative AF

VT, VF, cardiac arrest,

Unadjusted OR: 1.13 (1. 05 to

Trend towards longer LOS

2010 (178)

ARB (ABDT)

valve, single

paced rhythm (prior

matching (6,744

inotrope use, stroke, in

1.25); p<0.01

(p=0.07), however no evidence

prescription

site, 1997 to

history of AF

patients, 70%

hospital death, renal

found an association between

within 30 d and

2003

allowed)

cohort)

failure, pulmonary

preoperative angiotension

last dose within

embolism, LOS

blockade and occurrence of

24 h of surgery

POAF.

OR: 1.05 (0.95 to 1.16);

p=0.38

ABDT, indicates angiotensin-blocking drug therapy ACEI, angiotensin converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin II receptor blockers; CABG, coronary artery bypass graft; CI, confidence interval; h, hour; LOS, length of stay; MI, myocardial infarction; OPCAB, off-pump coronary artery bypass; OR, odds ratio; POAF, postoperative atrial fibrillation, VF, ventricular fibrillation; and VT, ventricular tachycardia.

© American College of Cardiology Foundation and American Heart Association, Inc.

Data Supplement 27. ACE Inhibitors: Table 2

Author (Trial)	Intervention	Number	Inclusion/Exclusion	Dates	Outcome	Results; HR (95% CI)
Kjoller-Hansen et. al. 2000	Ramipril 5 to 10 mg, 5 to 7	80	Key inclusion: preoperative LVEF	1994 to 1996, single	Triple (cardiac death, MI, CHF)	Reduction in triple composite only
(APRES) (179)	d post uncomplicated		0.3 to 0.5 and uncomplicated	Danish site, terminated	or quadruple composite	(58% risk reduction), (7% to 80%).
	CABG, median follow-up		postoperative course.	early (lack of enrollment)	outcome (recurrent angina)	Trend to higher incidence recurrent
	33 mo, 82% post-CABG		Exclusion: hx recent MI, clinical			angina first 6 mo. No interaction with
	(vs. PCI)		heart failure, or valve disease.			EF.
	Placebo	79
Oosterga et. al. 2001 (Quo	Quinapril (40 mg), 4	75	Key inclusion: exercise induced	1994 to 1997; 2 sites,	Clinical ischemic events,	Reduction of clinical ischemic events
Vadis) (180)	wkspreoperative,		ischemia. Key exclusions: clinical	Dutch	Ischemia on ETT, Holter	only
	prescription 1 y		heart failure, severe renal disease,			HR: 0.2; (95% CI: 0.06 to 0.87)
	postoperative		severe hypertension, AF, diuretic
			prescription
	Placebo	73
Rouleau et al. 2008	Quinapril (titrate up to 40	1,280	Key exclusion: insulin-dependent	1999 to 2004; 57 sites, 4	Composite MACE, CVA; drug	Primary outcome NS (HR: 1.15; 95%
(IMAGINE) (181)	mg), 7 to 10 d		diabetes mellitus, or type 2 diabetes	countries	AEs	CI: 0.92 to 1.42; p=0.212); first 3 mo
	postoperative, Prescription		with microalbuminuria, significant			postoperative worse outcome treated
	6 to 43 mo		renal disease, microalbuminuria,			group (HR: 1.60; 95% CI: 0.73 to
			preoperative LVEF <40%,			3.52; p=0.240), more AE's
			perioperative MI.
	Placebo	1,273
Fox et al. 2007	Perindopril 8 mg after 4 wk	3,340	Key inclusion: CAD without heart	1997 to 2000, multicenter	Primary (cardiovascular death,	CABG only in 3,136 patients, CABG
(182)	run in period. Prescription		failure. Key Exclusions: renal	European 24 countries	nonfatal MI or cardiac arrest) at	and PCI in 451, PCI only in 3122 pts.
	for at least 3 wk.		insufficiency; revascularization		4.2 y of follow-up	RRR 17.3% (95% CI: 1.3 to 30.8;
			within 6 mo of enrollment			p=0.035) (vs. 20% in entire EUROPA
						trial); RRR in pts without prior MI
						23% (95% CI: 2.7 to 42.2, p=0.074);
						RRR for fatal or nonfatal outcome
						alone 23% (95% CI: 4.9 to 37.6%;
						p=0.015).
	Placebo	3,369

AE indicates adverse event; AF, atrial fibrillation; APRES, Angiotension-converting Enzyme Inhibition Post Revascularization Study; CABG, coronary artery bypass graft; CAD, coronary artery disease; CI, confidence interval; CVA, cerebral vascular accident; d, day; EF, ejection fraction; ETT, exercise tolerance test; HTN, hypertension; HR, hazard ratio; hx, history; IMAGINE, Ischemia Management with Accupril post-bypass Graft via Inhibition of the converting Enzyme; LV, left ventricular; LVEF, left ventricular ejection fraction; m, month; MACE, major adverse cardiac events; MI, myocardial infarction; NS, non significant; PCI, percutaneous coronary infection; Quo Vadis, QUinapril on Vascular Ace and Determinants of Ischemia; RRR, relative risk reduction; w, week, and y, year.

© American College of Cardiology Foundation and American Heart Association, Inc.

Data Supplement 28. Smoking Cessation

Study Name	Study Type	Patient Population	Findings	Statistical Significance
		Sample Size
Cavender et al. 1992 (183)	Randomized	780	Increased survival in nonsmokers vs. smokers (82% and	p=0.025
	Study		77%, respectively)
Vlietstra et al. 1986 (184)	Observational Study	4,165	Lower mortality in quitters vs. those who continued to	N/A
			smoke (15% vs. 22% respectively)
			RR: 1.55; 95% CI: 1.29 to 1.85
Voors et al. 1996 (185)	Observational Study	415	No difference in survival; compared to nonsmokers,	N/A
			smokers were at increased risk for MI, repeat CABG and
			recurrent angina
van Domburg et al. 2000 (186)	Observational Study	985	Nonsmokers were less likely to undergo repeat CABG or	N/A
			PCI
			RR: 1.41; 95% CI: 1.02 to 1.94
van Domburg et al. 2008 (187)	Observational Study	1,041	Smoking cessation was an independent predictor of lower	N/A
			mortality
			HR: 0.60; 95% CI: 0.48 to 0.72

CABG indicates coronary artery bypass graft; CI, confidence interval; HR, hazard ratio; MI, myocardial infarction; N/A, not applicable; OR, odds ratio; PCI, percutaneous coronary intervention; and RR, relative risk.

Data Supplement 29. Cardiac Rehabilitation

Study Name	Study Type	Patient Population	Findings	Statistical Significance
		Sample Size
Engbloom et al. 1997 (188)	Randomized Trial	Post-CABG n=119 randomized to rehabilitation vs.	5 y rates of physical mobility, health status	p=0.002
		n=109 usual hospital treatment	improved
Millani et al. 1998 (189)	Observational Study	500 consecutive patients entering rehabilitation following	Decrease body fat 5% from 26.2±8.0 to 24.8±7.5	p<0.0001
		cardiac event (MI, PCI, CABG)
Hansen et al. 2009 (190)	Observational Study	PCI n=194 and CABG n=149 undergoing rehabilitation	CABG and PCI patients getting rehabilitation had	p<0.005
		compared to controls	lower 2 y mortality compared to controls
Moholdt et al. 2009 (191)	Randomized Trial	59 CABG randomized to AIT vs. MCT	4 wk and 6 mo follow-up with improved VO max	p<0.001
			in AIT group

AIT indicates aerobic interval training; CABG, coronary artery bypass graft; MCT, moderate continuous training; MI, myocardial infarction; mo, month; PCI, percutaneous coronary intervention; VO max, oxygen uptake maximum; wk, week; and y, year.

© American College of Cardiology Foundation and American Heart Association, Inc.

Data Supplement 30. Central Nervous System Monitoring

Author	Aim of Study	N of	Patients	Relative RR;	Absolute RR;	P-Value	Number of	RR; (95%	Absolute RR	P-	Comments
		Patients	With ≥1	(95% CI)	(95% CI)		Patients With	CI)	(95% CI)	Value
			MOMM				≥1 any STS		(%)
			Outcome				30-d Outcomes
			N (%)				N (%)
Murkin et al.	Active	100	3 (3%)	0.73; (95% CI:	0.08; (95%	0.048	23 (23%)	0.25 (95% CI:	0.10; (95% CI:	NS	MOMM variables: death,
2007(192)	intraoperative			0.05 to 0.92)	CI: 0.01 to			-0.10 to 0.49)	-0.03 to 0.23)		ventilation >48 h, stroke, MI,
	rSO cerebral				0.15)						return for reexploration; alarm
	oximetry										threshold of 75% of resting rSO
	monitoring with										used for intervention;
	treatment										concomitant procedure or
											OPCAB in 12 control vs. 7
											intervention patients
	Active	100	11 (11%)				30 (30%)
	intraoperative
	rSO cerebral
	oximetry
	monitoring with
	treatment
			Postoperativ				Other major
			e Cognitive				postoperative
			Decline				complications
Slater et al. 2009	Active	125	73 (58%)	0.05 (95% CI:	0.03 (95% CI:	NS	6 (5%)	0 (95% CI:	0 (95% CI: -	NS	Other complications=CVA, MI,
(193)	intraoperative			0.17 to 0.23)	-0.09 to 0.15)			-202 to 67)	0.06 to 0.06)		renal insufficiency, reoperation;
	rSO cerebral										prolonged rSO was higher in
	oximetry										pooled cognitive decline patients
	monitoring with										(33% vs. 20%; p=0.02) and was
	treatment										associated with hospital stay >6
											d (25%) OR: 2.71 (95% CI 1.3
											to 5.6); p=0.007
	Active	115	70 (61%)				6 (5%)
	intraoperative
	rSO cerebral
	oximetry
	monitoring with
	treatment

CI indicates confidence interval; CVA, cerebral vascular accident, MI, myocardial infarction; MOMM, major organ morbidity and mortality; N, number; NS, non-significant; OPCAB, off-pump coronary artery bypass; RR, relative risk; rSO , regional oxygen saturation; and STS, Society of Thoracic Surgeons.

© American College of Cardiology Foundation and American Heart Association, Inc.

Data Supplement 31. Performance

Article Name	Aim of Study	Study Design	Study Size	Patient Population	Endpoints	Results
Comparing hospitals	To determine if hospital	Observational	2,867 CABG patients	10 WI hospitals, April 1990	Risk-adjusted mortality and	Low correlations between adjusted hospital
that perform CABG: the	quality comparisons			to June 1991	morbidity	rankings derived from the clinical and
effect of outcome	impacted by use of					administrative databases were 0.48 for
measures and data	administrative vs. clinical					mortality, 0.21 for major complications, and -
sources. 1994 (194)	data					0.14 for any complication.
						Assessing provider quality using administrative
						data may not be adequate.
Using Medicare claims	Determine adequacy of	Observational,	13,577 CABG patients	Isolated CABG patients, NY	Model performance, outcomes,	Performance of administrative models
data to assess provider	administrative claims data	comparing risk		state, 1991 to 1992	outlier determination.	diminished substantially when complications
quality for CABG: does	for profiling.	models and provider				separated from co-morbidities (from c-
it work well enough?		performance based				index=0.78 to c-index=0.71 and c-index=0.73).
1997 (195)		on Medicare vs. NY
		clinical data registry.				NY clinical registry-based model based on all
						patients had best performance (c-
						statistic=0.813).
						Different risk-adjusted mortality rates and
						outliers using administrative vs. clinical data.
						Clinical database better for profiling
						Performance of administrative models improved
						by adding a few clinical variables
Clinical versus	To compare the ability of	Observational,	22, 827 CABG	NY CABG patients, 1989 to	Risk factor coding, observed and	Substantial differences between databases in
administrative data	clinical and administrative	comparing NY	patients	1990	risk-adjusted mortality, outlier	risk factor coding.
bases for CABG. Does	databases to predict CABG	clinical and			determination.
it matter? 1992 (196)	mortality and assess provider	administrative				For some hospitals, substantial differences
	performance.	databases.				between risk-adjusted mortality rates and
						ranking determined by administrative model and
						clinical model (the gold standard).
						Clinical data much better at predicting mortality
						and for use in profiling.
						Administrative model can be improved with the
						addition of some clinical variables.
Does reporting of	To assess accuracy of CABG	Observational,	1,121 confirmed	Single hospital isolated	Case volumes and mortality rates	Case volumes over-reported as much as 21% in

© American College of Cardiology Foundation and American Heart Association, Inc.

coronary artery bypass	outcomes from	comparing STS	CABG patients	CABG 1999 to 2001		all patients, underreported up to 16% or more in
grafting from	administrative databases	database results with				Medicare patients
administrative		those from 4
databases accurately		administrative data				Mortality in administrative data exceeded that in
reflect actual clinical		sources and risk				clinical data by 21%.
outcomes? 2005 (197)		models.
						Different administrative data-derived risk
						models had risk-adjusted mortality rates that
						exceeded STS rates by as much as 61%
Comparison of clinical	To compare the accuracy of	Observational,	4,440 isolated CABG	MA CABG patients, FY	Observed and risk-adjusted	27% higher number of patients (5,657 vs. 4,440
and administrative data	administrative and clinical	comparing audited,	in audited clinical	2003	mortality, outliers.	actual) in administrative data due to
sources for hospital	data sources for public report	clinical registry and	registry, 5,657			inappropriate inclusion of nonisolated CABG
coronary artery bypass	cards.	state administrative	“CABG” in state			cases.
graft report cards. 2007		data.	administrative data.
(198)						Administrative data in-hospital mortality 2.88%
						vs. 2.05% in audited clinical registry.
						Differences in risk-adjusted mortality rates and
						outliers between administrative and clinical data
						based-models.
						Recommend clinical data for profiling.
Mortality after cardiac	To compare mortality	Observational	15,288 CABG patients	43 VA hospitals, October 1,	Model performance, risk-adjusted	Administrative model c-index=0.698, clinical
bypass surgery:	prediction and outlier			1993, to March 30, 1996	mortality rates, outliers.	model c-index=0.761.
prediction from	determination from
administrative versus	administrative vs. clinical					6 hospitals (14%) changed more than 2 deciles
clinical data. 2005	data.					in rank when using administrative vs. clinical
(199)						data.
						Administrative models identified only 2 of 6
						high and 1 of 4 low outlier hospitals determined
						by the clinical model.
						Clinical models have better performance, but
						administrative models can be improved by
						adding clinical variables
Assessing the outcomes	To determine the impact of	Observational,	5,517 isolated CABG	Ontario, FY 1993, 9	Model performance, risk adjusted	Model performance stable after the inclusion of
of coronary artery	number of risk factors on the	comparing the	patients.	hospitals.	mortality rates, and rankings.	6 core clinical variables (c-index=0.77).
bypass graft: how many	accuracy of risk-adjusted	results of models
risk factors are enough?	mortality rates.	using an increasing				In comparison with unadjusted results, 6-
1997 (200)		number of risk				variable clinical model resulted in a change in
		factors.				risk-adjusted mortality rates and rankings for

© American College of Cardiology Foundation and American Heart Association, Inc.

most hospitals.

CABG, coronary artery bypass graft; FY; fiscal year; MA, Massachusetts; NY, New York; STS, Society of Thoracic Surgeons; VA, Veterans Administration; and WI, Wisconsin.

Data Supplement 32. Outcomes or Volume as CABG Quality Measures

Article Name

Aim of Study

Study Design

Study Size

Patient

Endpoints

Results

population/Year/Hospital

Should operations be

To determine the impact

Observational

34,505 CABG patients

CABG patients/1974 to

Adjusted mortality

Mortality 5.7% for ≤200 CABG; 3.4% for >200

regionalized? The empirical

of volume on mortality.

1975/The Professional

CABG.

relation between surgical

Activity Study Database.

volume and mortality. 1979

(201)

Hospital volume and

To determine the

Observational

901,667 CABG patients

Medicare CABG patients/

Adjusted mortality

Continuous inverse association between volume and

surgical mortality in the

association between

1994 to 1999/1,068 hospitals.

outcome.

United States. 2002 (202)

procedural volume and

mortality.

Adjusted mortality 5.6% for <230 procedures vs. 4.5%

for >849 procedures.

Relatively weak association compared to other

procedures.

Association of volume with

To determine volume-

Observational

18,986 CABG patients

CA CABG patients/1983/ 77

Adjusted mortality

Patients undergoing CABG in hospitals with volume

outcome of CABG.

outcome association for

hospitals

>350 cases had lowest mortality, and this effect was

Scheduled vs. nonscheduled

scheduled vs.

most pronounced in nonscheduled cases.

operations. 1987 (203)

nonscheduled

operations.

Regionalization of cardiac

To determine the impact

Observational

116,593 CABG patients

CABG patients in NY,

Adjusted mortality

Highest adjusted mortality rate (4.7%) in CA CABG

surgery in the United States

of CABG

Canada, and CA/1987 to 1989.

patients having surgery at hospitals with annual volume

and Canada. Geographic

regionalization.

<100 CABG.

access, choice, and

outcomes. 1995 (204)

CABG: the relationship

To determine association

Observational

12,448 CABG patients

NY isolated CABG

Risk-adjusted mortality

Overall crude mortality rate 3.68%.

between in-hospital

of hospital and surgeon

patients/1989/126 surgeons, 30

mortality rate and surgical

volume with CABG

hospitals

Crude mortality rates decrease monotonically from

volume after controlling for

outcome.

5.38% for hospital volumes 1 to 199 to 3.08% for

clinical risk factors. 1991

Cardiac Surgery Reporting

hospital volumes ≥890.

(205)

System.

Hospital risk-adjusted mortality rates decrease

© American College of Cardiology Foundation and American Heart Association, Inc.