title: Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study).
abstract: BACKGROUND
  Most survival prediction models for coronary artery bypass grafting surgery are limited to in-hospital or 30-day end points. We estimate a long-term survival model using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and Centers for Medicare and Medicaid Services.
  
  
  RESULTS
  The final study cohort included 348 341 isolated coronary artery bypass grafting patients aged ≥65 years, discharged between January 1, 2002, and December 31, 2007, from 917 Society of Thoracic Surgeons-participating hospitals, randomly divided into training (n=174 506) and validation (n=173 835) samples. Through linkage with Centers for Medicare and Medicaid Services claims data, we ascertained vital status from date of surgery through December 31, 2008 (1- to 6-year follow-up). Because the proportional hazards assumption was violated, we fit 4 Cox regression models conditional on being alive at the beginning of the following intervals: 0 to 30 days, 31 to 180 days, 181 days to 2 years, and >2 years. Kaplan-Meier-estimated mortality was 3.2% at 30 days, 6.4% at 180 days, 8.1% at 1 year, and 23.3% at 3 years of follow-up. Harrell's C statistic for predicting overall survival time was 0.732. Some risk factors (eg, emergency status, shock, reoperation) were strong predictors of short-term outcome but, for early survivors, became nonsignificant within 2 years. The adverse impact of some other risk factors (eg, dialysis-dependent renal failure, insulin-dependent diabetes mellitus) continued to increase.
  
  
  CONCLUSIONS
  Using clinical registry data and longitudinal claims data, we developed a long-term survival prediction model for isolated coronary artery bypass grafting. This provides valuable information for shared decision making, comparative effectiveness research, quality improvement, and provider profiling.
authors.affiliation: Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA. dshahian@partners.org
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Shubin
authors.initials: S
authors.lastname: Sheng
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Weiss
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Delong
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau-Sepulveda
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
authors.forename: Issam D
authors.initials: ID
authors.lastname: Moussa
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Shewan
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000639:trends*; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012955:Societies, Medical / Q000639:trends*; D017741:Survivors; D013903:Thoracic Surgery / Q000639:trends*