Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery

B. R. Chaitman, E. L. Alderman, L. T. Sheffield, T. Tong, L. Fisher, M. B. Mock, R. D. Weins, G. C. Kaiser, D. Roitman, R. Berger, B. Gersh, Hartzell V Schaff, M. G. Bourassa, T. Killip

Research output: Contribution to journalArticle

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Abstract

There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave infarction was 4.6% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (p < 0.001); the 3-year cumulative survival rates were 85% and 95%, respectively (p < 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94% and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to that among patients who did not. We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.

Original languageEnglish (US)
Pages (from-to)302-309
Number of pages8
JournalCirculation
Volume67
Issue number2
StatePublished - 1983

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Survival Analysis
Infarction
Transplants
Survival
Cardiomegaly
Cardiopulmonary Bypass
Survival Rate
Patient Readmission
Discriminant Analysis
Hospital Mortality
Hypothermia
Left Ventricular Function
Coronary Vessels
Thorax
Blood Pressure
Morbidity
Mortality
Incidence

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Chaitman, B. R., Alderman, E. L., Sheffield, L. T., Tong, T., Fisher, L., Mock, M. B., ... Killip, T. (1983). Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery. Circulation, 67(2), 302-309.

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery. / Chaitman, B. R.; Alderman, E. L.; Sheffield, L. T.; Tong, T.; Fisher, L.; Mock, M. B.; Weins, R. D.; Kaiser, G. C.; Roitman, D.; Berger, R.; Gersh, B.; Schaff, Hartzell V; Bourassa, M. G.; Killip, T.

In: Circulation, Vol. 67, No. 2, 1983, p. 302-309.

Research output: Contribution to journalArticle

Chaitman, BR, Alderman, EL, Sheffield, LT, Tong, T, Fisher, L, Mock, MB, Weins, RD, Kaiser, GC, Roitman, D, Berger, R, Gersh, B, Schaff, HV, Bourassa, MG & Killip, T 1983, 'Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery', Circulation, vol. 67, no. 2, pp. 302-309.
Chaitman BR, Alderman EL, Sheffield LT, Tong T, Fisher L, Mock MB et al. Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery. Circulation. 1983;67(2):302-309.
Chaitman, B. R. ; Alderman, E. L. ; Sheffield, L. T. ; Tong, T. ; Fisher, L. ; Mock, M. B. ; Weins, R. D. ; Kaiser, G. C. ; Roitman, D. ; Berger, R. ; Gersh, B. ; Schaff, Hartzell V ; Bourassa, M. G. ; Killip, T. / Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery. In: Circulation. 1983 ; Vol. 67, No. 2. pp. 302-309.
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abstract = "There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave infarction was 4.6{\%} (range 0.0-10.3{\%} by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7{\%} in the 62 patients who had new postoperative Q waves and 1.0{\%} in the 1278 patients who did not (p < 0.001); the 3-year cumulative survival rates were 85{\%} and 95{\%}, respectively (p < 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94{\%} and 96{\%}, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to that among patients who did not. We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.",
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AU - Mock, M. B.

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AU - Killip, T.

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N2 - There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave infarction was 4.6% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (p < 0.001); the 3-year cumulative survival rates were 85% and 95%, respectively (p < 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94% and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to that among patients who did not. We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.

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