Mark S. Lesney

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery. The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas at the annual meeting of the Society of Thoracic Surgeons.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power. "This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies," Dr. Puskas said in an interview.

"The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy," he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996-2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM.

The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.
The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

SAN DIEGO - Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting.

In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).

Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed from 1986 to 2008. Patency was examined over time by coronary territory and by whether the RITA was in situ or free, and was compared with other coronary conduits, according to the study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.

The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436), 85% (n = 199) to the right coronary artery (RCA), and 86% (n = 207) to the posterior descending artery (PDA). Ten-year patencies of RITA and LITA to the left anterior descending artery were identical.

In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.

RITA patency was found to be significantly better than radial artery and saphenous vein grafts for the circumflex marginal artery, the RCA, and the PDA. The 10-year survival of patients with RITA and LITA for triple-vessel coronary disease were identical at 89%.

Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.

“Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.

Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.

Left ventricular unloading in patients with end-stage heart failure has been shown to improve with the use of a left-ventricular assist device, according to the results of several recent clinical studies. This improvement includes favorable changes in myocardial structure and function, including beta-adrenergic responsiveness and myocyte contractility.

Several molecular and genetic mechanisms have been correlated with these changes and might provide the basis for improvements in device behavior, as well as indications for potential targets for new therapeutic drugs and altered regimens for existing drugs.

Such new treatments may have the potential to benefit not only patients who have received LVADs, but also heart failure patients as a whole, as reported in a state-of-the-art article (J. Am. Coll. Cardiol. 2011;57:641-52).

The LVAD population presents a unique and valuable opportunity to obtain myocardial tissue of patients with end-stage heart failure (HF) at the time of implantation, and often at the time of heart and/or LVAD explantation, after a period of unloading, according to Jennifer L. Hall, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in the United States and Europe. These tissue samples allow paired comparisons of before and after changes in molecular, genetic, and cytologic markers indicative of improvements that occur with the reverse remodeling of the human heart seen in response to LVADs.

The researchers supported their conclusions with a review of recent clinical trials and assembled data from a report by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) covering the years 2006–2009, which included the introduction of continuous-flow technology as well as the original pulsatile flow devices.

Mechanical improvements in failing hearts treated with LVADS have been characterized by partial recovery of the contractile performance of myocytes. This includes improvements of the magnitude of shortening in isolated myocytes in response to beta-adrenergic agonists, of basal relaxation, and in the rise and fall in tension in trabecular muscle preparations.

Relevant markers and pathways found to be improved or normalized by LVAD support included:

Beta-adrenergic signalling. Improvements in developed tension with LVADs have been shown to be associated with an increased beta-adrenergic receptor density. Because a novel combination of LVAD support and pharmacologic therapy – including the selective beta-2 agonist clenbuterol – showed promise in restoring ventricular function in patients with heart failure, investigators analyzed six paired human heart samples isolated at the time of LVAD implantation and at the time of LVAD explantation due to sufficient myocardial recovery. Significant changes to a number of genes in the beta-adrenergic signaling pathway occurred in recovering hearts.

Calcium handling. Although improvements in basal relaxation rates with LVADs have not been definitively linked to changes in calcium handling, the largest improvements in action potential and sarcoplasmic reticulum calcium content occurred in patients who achieved clinical recovery in response to LVADs and pharmacological therapy. However, improvements in calcium handling and contractility appear time dependent, with patients with shorter durations of support (less than 115 days) showing improvement, which reverted back to failing levels in patients with longer durations of support.

Metabolism and growth factor–related genes. Several genes that regulated metabolism were found to change their expression during LVAD-supported recovery. These included arginine:glycine amidinotransferase (AGAT), a rate-limiting enzyme in the creatine synthesis pathway, which was significantly down-regulated after unloading in the recovered hearts, returning to normal levels, in direct contrast to the up-regulation of AGAT seen in patients with heart failure. Insulin growth factor was elevated in patients at the time of LVAD explantation due to recovery. This was thought to aid in limiting atrophy and apoptosis during reverse remodeling and to promote repair and regeneration.

Natriuretic peptides and chromogranin A. Unloading a failing heart with an LVAD was associated with a decrease in natriuretic peptides (which are activated during heart failure) and reestablishment of the local responsiveness of a key enzyme, chromogranin A, to cardiac atrial natriuretic peptide.

But all is not perfect in the LVAD-supported heart. In one study, there was a significant increase in total and cross-linked collagen in the myocardium, compared with nonfailing and medically managed patients with heart failure, which correlated with increased left ventricular stiffness. “Interestingly, the majority of [these] LVAD patients after implantation were not on ACE inhibitors, which have been demonstrated to improve fibrosis and remodeling,” the authors wrote.

A subsequent retrospective cohort study of the same group, comparing LVAD patients who did and did not receive ACE inhibitor therapy after implantation, showed a significant decrease in collagen content and myocardial stiffness in the cohort with LVADs and ACE inhibitors. “These findings support the hypothesis that maximizing optimal medical management after ventricular unloading with LVADs may promote myocardial recovery.”

The study was sponsored by the National Institutes of Health, the American Heart Association, and the National Institutes for Health Research Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust, and Imperial College London. Several of the authors reported receiving research support and/or honoraria or speakers fees from Thoratec, Heartware Inc., and Medtronic, all manufacturers of LVADs.

Left ventricular unloading in patients with end-stage heart failure has been shown to improve with the use of a left-ventricular assist device, according to the results of several recent clinical studies. This improvement includes favorable changes in myocardial structure and function, including beta-adrenergic responsiveness and myocyte contractility.

Several molecular and genetic mechanisms have been correlated with these changes and might provide the basis for improvements in device behavior, as well as indications for potential targets for new therapeutic drugs and altered regimens for existing drugs.

Such new treatments may have the potential to benefit not only patients who have received LVADs, but also heart failure patients as a whole, as reported in a state-of-the-art article (J. Am. Coll. Cardiol. 2011;57:641-52).

The LVAD population presents a unique and valuable opportunity to obtain myocardial tissue of patients with end-stage heart failure (HF) at the time of implantation, and often at the time of heart and/or LVAD explantation, after a period of unloading, according to Jennifer L. Hall, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in the United States and Europe. These tissue samples allow paired comparisons of before and after changes in molecular, genetic, and cytologic markers indicative of improvements that occur with the reverse remodeling of the human heart seen in response to LVADs.

The researchers supported their conclusions with a review of recent clinical trials and assembled data from a report by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) covering the years 2006–2009, which included the introduction of continuous-flow technology as well as the original pulsatile flow devices.

Mechanical improvements in failing hearts treated with LVADS have been characterized by partial recovery of the contractile performance of myocytes. This includes improvements of the magnitude of shortening in isolated myocytes in response to beta-adrenergic agonists, of basal relaxation, and in the rise and fall in tension in trabecular muscle preparations.

Relevant markers and pathways found to be improved or normalized by LVAD support included:

Beta-adrenergic signalling. Improvements in developed tension with LVADs have been shown to be associated with an increased beta-adrenergic receptor density. Because a novel combination of LVAD support and pharmacologic therapy – including the selective beta-2 agonist clenbuterol – showed promise in restoring ventricular function in patients with heart failure, investigators analyzed six paired human heart samples isolated at the time of LVAD implantation and at the time of LVAD explantation due to sufficient myocardial recovery. Significant changes to a number of genes in the beta-adrenergic signaling pathway occurred in recovering hearts.

Calcium handling. Although improvements in basal relaxation rates with LVADs have not been definitively linked to changes in calcium handling, the largest improvements in action potential and sarcoplasmic reticulum calcium content occurred in patients who achieved clinical recovery in response to LVADs and pharmacological therapy. However, improvements in calcium handling and contractility appear time dependent, with patients with shorter durations of support (less than 115 days) showing improvement, which reverted back to failing levels in patients with longer durations of support.

Metabolism and growth factor–related genes. Several genes that regulated metabolism were found to change their expression during LVAD-supported recovery. These included arginine:glycine amidinotransferase (AGAT), a rate-limiting enzyme in the creatine synthesis pathway, which was significantly down-regulated after unloading in the recovered hearts, returning to normal levels, in direct contrast to the up-regulation of AGAT seen in patients with heart failure. Insulin growth factor was elevated in patients at the time of LVAD explantation due to recovery. This was thought to aid in limiting atrophy and apoptosis during reverse remodeling and to promote repair and regeneration.

Natriuretic peptides and chromogranin A. Unloading a failing heart with an LVAD was associated with a decrease in natriuretic peptides (which are activated during heart failure) and reestablishment of the local responsiveness of a key enzyme, chromogranin A, to cardiac atrial natriuretic peptide.

But all is not perfect in the LVAD-supported heart. In one study, there was a significant increase in total and cross-linked collagen in the myocardium, compared with nonfailing and medically managed patients with heart failure, which correlated with increased left ventricular stiffness. “Interestingly, the majority of [these] LVAD patients after implantation were not on ACE inhibitors, which have been demonstrated to improve fibrosis and remodeling,” the authors wrote.

A subsequent retrospective cohort study of the same group, comparing LVAD patients who did and did not receive ACE inhibitor therapy after implantation, showed a significant decrease in collagen content and myocardial stiffness in the cohort with LVADs and ACE inhibitors. “These findings support the hypothesis that maximizing optimal medical management after ventricular unloading with LVADs may promote myocardial recovery.”

The study was sponsored by the National Institutes of Health, the American Heart Association, and the National Institutes for Health Research Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust, and Imperial College London. Several of the authors reported receiving research support and/or honoraria or speakers fees from Thoratec, Heartware Inc., and Medtronic, all manufacturers of LVADs.

Left ventricular unloading in patients with end-stage heart failure has been shown to improve with the use of a left-ventricular assist device, according to the results of several recent clinical studies. This improvement includes favorable changes in myocardial structure and function, including beta-adrenergic responsiveness and myocyte contractility.

Several molecular and genetic mechanisms have been correlated with these changes and might provide the basis for improvements in device behavior, as well as indications for potential targets for new therapeutic drugs and altered regimens for existing drugs.

Such new treatments may have the potential to benefit not only patients who have received LVADs, but also heart failure patients as a whole, as reported in a state-of-the-art article (J. Am. Coll. Cardiol. 2011;57:641-52).

The LVAD population presents a unique and valuable opportunity to obtain myocardial tissue of patients with end-stage heart failure (HF) at the time of implantation, and often at the time of heart and/or LVAD explantation, after a period of unloading, according to Jennifer L. Hall, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in the United States and Europe. These tissue samples allow paired comparisons of before and after changes in molecular, genetic, and cytologic markers indicative of improvements that occur with the reverse remodeling of the human heart seen in response to LVADs.

The researchers supported their conclusions with a review of recent clinical trials and assembled data from a report by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) covering the years 2006–2009, which included the introduction of continuous-flow technology as well as the original pulsatile flow devices.

Mechanical improvements in failing hearts treated with LVADS have been characterized by partial recovery of the contractile performance of myocytes. This includes improvements of the magnitude of shortening in isolated myocytes in response to beta-adrenergic agonists, of basal relaxation, and in the rise and fall in tension in trabecular muscle preparations.

Relevant markers and pathways found to be improved or normalized by LVAD support included:

Beta-adrenergic signalling. Improvements in developed tension with LVADs have been shown to be associated with an increased beta-adrenergic receptor density. Because a novel combination of LVAD support and pharmacologic therapy – including the selective beta-2 agonist clenbuterol – showed promise in restoring ventricular function in patients with heart failure, investigators analyzed six paired human heart samples isolated at the time of LVAD implantation and at the time of LVAD explantation due to sufficient myocardial recovery. Significant changes to a number of genes in the beta-adrenergic signaling pathway occurred in recovering hearts.

Calcium handling. Although improvements in basal relaxation rates with LVADs have not been definitively linked to changes in calcium handling, the largest improvements in action potential and sarcoplasmic reticulum calcium content occurred in patients who achieved clinical recovery in response to LVADs and pharmacological therapy. However, improvements in calcium handling and contractility appear time dependent, with patients with shorter durations of support (less than 115 days) showing improvement, which reverted back to failing levels in patients with longer durations of support.

Metabolism and growth factor–related genes. Several genes that regulated metabolism were found to change their expression during LVAD-supported recovery. These included arginine:glycine amidinotransferase (AGAT), a rate-limiting enzyme in the creatine synthesis pathway, which was significantly down-regulated after unloading in the recovered hearts, returning to normal levels, in direct contrast to the up-regulation of AGAT seen in patients with heart failure. Insulin growth factor was elevated in patients at the time of LVAD explantation due to recovery. This was thought to aid in limiting atrophy and apoptosis during reverse remodeling and to promote repair and regeneration.

Natriuretic peptides and chromogranin A. Unloading a failing heart with an LVAD was associated with a decrease in natriuretic peptides (which are activated during heart failure) and reestablishment of the local responsiveness of a key enzyme, chromogranin A, to cardiac atrial natriuretic peptide.

But all is not perfect in the LVAD-supported heart. In one study, there was a significant increase in total and cross-linked collagen in the myocardium, compared with nonfailing and medically managed patients with heart failure, which correlated with increased left ventricular stiffness. “Interestingly, the majority of [these] LVAD patients after implantation were not on ACE inhibitors, which have been demonstrated to improve fibrosis and remodeling,” the authors wrote.

A subsequent retrospective cohort study of the same group, comparing LVAD patients who did and did not receive ACE inhibitor therapy after implantation, showed a significant decrease in collagen content and myocardial stiffness in the cohort with LVADs and ACE inhibitors. “These findings support the hypothesis that maximizing optimal medical management after ventricular unloading with LVADs may promote myocardial recovery.”

The study was sponsored by the National Institutes of Health, the American Heart Association, and the National Institutes for Health Research Cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield National Health Service Foundation Trust, and Imperial College London. Several of the authors reported receiving research support and/or honoraria or speakers fees from Thoratec, Heartware Inc., and Medtronic, all manufacturers of LVADs.

Major Finding: The STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

Data Source: A retrospective analysis of 24,222 patients who underwent cardiac surgery at a single academic center between Jan. 1, 1996, and Dec. 31, 2009.

Disclosures: Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO – The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery.

The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

“This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies,” Dr. Puskas said in an interview.

“The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short- and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy,” he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996–2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM. The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.

The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

The models are 'underutilized and underappreciated in their power to predict short- and long-term outcomes.'

Source DR. PUSKAS

Major Finding: The STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

Data Source: A retrospective analysis of 24,222 patients who underwent cardiac surgery at a single academic center between Jan. 1, 1996, and Dec. 31, 2009.

Disclosures: Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO – The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery.

The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

“This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies,” Dr. Puskas said in an interview.

“The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short- and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy,” he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996–2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM. The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.

The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

The models are 'underutilized and underappreciated in their power to predict short- and long-term outcomes.'

Source DR. PUSKAS

Major Finding: The STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

Data Source: A retrospective analysis of 24,222 patients who underwent cardiac surgery at a single academic center between Jan. 1, 1996, and Dec. 31, 2009.

Disclosures: Dr. Puskas and his colleagues reported no relevant disclosures with regard to their study.

SAN DIEGO – The Society of Thoracic Surgeons Predicted Risk of Mortality score is a well-validated predictor of mortality during the first 30 days after cardiac surgery.

The PROM score's role in predicting longer-term survival, however, has not been investigated, according to Dr. John D. Puskas.

To fill this void, Dr. Puskas and his colleagues from Emory University, Atlanta, undertook a study to statistically validate PROM at 1, 3, 5, and 10 years after cardiac surgery. He presented the study's results at the meeting.

The investigators found that the STS PROM algorithm accurately predicted mortality both at 30 days and during 12 years of follow-up with almost equally strong discriminatory power.

“This may have profound implications for informed consent as well as for longitudinal comparative effectiveness studies,” Dr. Puskas said in an interview.

“The STS Predicted Risk of Mortality models are probably underutilized and underappreciated in their power to predict short- and long-term outcomes for our patients. The STS provides this service free of charge, and it is available online 24/7. I am hopeful that this newfound ability to predict longer-term survival after cardiac surgery will find utility in comparative effectiveness research and ultimately in shaping health policy,” he added.

Dr. Puskas and his colleagues evaluated the survival rates for 24,222 patients who underwent cardiac surgery at a single academic center during 1996–2009. Long-term all-cause mortality was determined by referencing the national Social Security Death Master File. Logistic and Cox survival regression analyses were used to evaluate the long-term predictive utility of PROM. The AUROC (area under the receiver operator characteristic) curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for both the whole sample and 30-day survivors.

The investigators found an overall 30-day mortality rate of 2.78%.

Among all patients and 30-day survivors, AUROC values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated.

Moreover, PROM was highly predictive of Kaplan-Meier survival, even when this analysis was restricted to patients surviving beyond 30 days, he added.

Among 30-day survivors, each percent increase in PROM score was significantly associated with a 9.6% increase in instantaneous hazard of death (P less than .001).

The models are 'underutilized and underappreciated in their power to predict short- and long-term outcomes.'

Source DR. PUSKAS