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Coronary Artery Disease: HELP
Articles by Frederick L. Grover
Based on 12 articles published since 2008
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Between 2008 and 2019, Frederick L. Grover wrote the following 12 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. 2012

Anonymous780721 / Patel, Manesh R / Dehmer, Gregory J / Hirshfeld, John W / Smith, Peter K / Spertus, John A / Anonymous790721 / Masoudi, Frederick A / Dehmer, Gregory J / Patel, Manesh R / Smith, Peter K / Chambers, Charles E / Ferguson, T Bruce / Garcia, Mario J / Grover, Frederick L / Holmes, David R / Klein, Lloyd W / Limacher, Marian C / Mack, Michael J / Malenka, David J / Park, Myung H / Ragosta, Michael / Ritchie, James L / Rose, Geoffrey A / Rosenberg, Alan B / Russo, Andrea M / Shemin, Richard J / Weintraub, William S / Anonymous800721 / Wolk, Michael J / Bailey, Steven R / Douglas, Pamela S / Hendel, Robert C / Kramer, Christopher M / Min, James K / Patel, Manesh R / Shaw, Leslee / Stainback, Raymond F / Allen, Joseph M / Anonymous810721 / Anonymous820721 / Anonymous830721 / Anonymous840721 / Anonymous850721 / Anonymous860721 / Anonymous870721 / Anonymous880721. · ·J Thorac Cardiovasc Surg · Pubmed #22424518.

ABSTRACT: The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.

2 Editorial Current status of off-pump coronary-artery bypass. 2012

Grover, Frederick L. · ·N Engl J Med · Pubmed #22449294.

ABSTRACT: -- No abstract --

3 Article Concordance between administrative data and clinical review for mortality in the randomized on/off bypass follow-up study (ROOBY-FS). 2017

Quin, Jacquelyn A / Hattler, Brack / Shroyer, Annie Laurie W / Kemp, Darlene / Almassi, G Hossein / Bakaeen, Faisal G / Carr, Brendan M / Bishawi, Muath / Collins, Joseph F / Grover, Frederick L / Wagner, Todd H / Anonymous2660930. ·Surgical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts. · Harvard Medical School, Boston, Massachusetts. · Department of Medicine, Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado. · School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, Colorado. · Research and Development Office, Northport Veterans Affair Medical Center, Northport, New York. · Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado. · Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland. · Surgical Services, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin. · Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. · Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania. · Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. · Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York. · Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota. · Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. · Department of Surgery, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado. · Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, California. · Department of Surgery, Stanford University, Stanford, California. ·J Card Surg · Pubmed #29239024.

ABSTRACT: BACKGROUND: The optimal methodology to identify cardiac versus non-cardiac cause of death following cardiac surgery has not been determined. METHODS: The Randomized On/Off Bypass Trial was a multicenter, randomized, controlled clinical trial of 2203 patients (February 2002-May 2008) comparing 1-year cardiac outcomes between off-pump and on-pump bypass surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program funded a follow-up study to assess 5-year outcomes including mortality. Deaths were identified and confirmed using the National Death Index (NDI), VA Vital Status file, and medical records. An Endpoints Committee (EC) reviewed patient medical records and classified each cause of death as cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI death certificates were independently used to classify deaths as cardiac or non-cardiac. Cause of death was compared between the NDI and EC classifications and concordance measured, using Kappa statistics. RESULTS: Of the 297 5-year deaths identified by the NDI and/or VA vital status file and confirmed by the EC, 219 had adequate patient records for EC cause of death determination. The EC adjudicated 141 of these deaths as non-cardiac and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). CONCLUSIONS: Since concordance between EC and NDI cause of death classifications was only moderate, caution should be exercised in relying exclusively on NDI data to determine cause of death. A hybrid approach, integrating multiple information sources, may provide the most accurate approach to classifying cause of death.

4 Article Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons Adult Cardiac Surgery Database. 2016

Jacobs, Jeffrey P / Shahian, David M / He, Xia / O'Brien, Sean M / Badhwar, Vinay / Cleveland, Joseph C / Furnary, Anthony P / Magee, Mitchell J / Kurlansky, Paul A / Rankin, J Scott / Welke, Karl F / Filardo, Giovanni / Dokholyan, Rachel S / Peterson, Eric D / Brennan, J Matthew / Han, Jane M / McDonald, Donna / Schmitz, DeLaine / Edwards, Fred H / Prager, Richard L / Grover, Frederick L. ·Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida. Electronic address: jeffjacobs@msn.com. · Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina. · University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · University of Colorado Denver, School of Medicine, Aurora, Colorado. · Starr-Wood Cardiac Group, Portland, Oregon. · Medical City Dallas Hospital, Baylor University Medical Center Dallas, Dallas, Texas. · Columbia University, New York, New York. · Vanderbilt University, Nashville, Tennessee. · Section of Congenital Cardiovascular Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, Illinois. · Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas. · The Society of Thoracic Surgeons (STS), Chicago, Illinois. · University of Florida College of Medicine, Jacksonville, Florida. · University of Michigan, Ann Arbor, Michigan. ·Ann Thorac Surg · Pubmed #26542437.

ABSTRACT: BACKGROUND: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) has been successfully linked to the Centers for Medicare and Medicaid (CMS) Medicare database, thereby facilitating comparative effectiveness research and providing information about long-term follow-up and cost. The present study uses this link to determine contemporary completeness, penetration, and representativeness of the STS ACSD. METHODS: Using variables common to both STS and CMS databases, STS operations were linked to CMS data for all CMS coronary artery bypass graft (CABG) surgery hospitalizations discharged between 2000 and 2012, inclusive. For each CMS CABG hospitalization, it was determined whether a matching STS record existed. RESULTS: Center-level penetration (number of CMS sites with at least one matched STS participant divided by the total number of CMS CABG sites) increased from 45% in 2000 to 90% in 2012. In 2012, 973 of 1,081 CMS CABG sites (90%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations done at STS sites divided by the total number of CMS CABG hospitalizations) increased from 51% in 2000 to 94% in 2012. In 2012, 71,634 of 76,072 CMS CABG hospitalizations (94%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by the total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2012. In 2012, 69,213 of 70,932 CMS CABG hospitalizations at STS sites (98%) were linked to an STS record. CONCLUSIONS: Linkage of STS and CMS databases demonstrates high and increasing penetration and completeness of the STS database. Linking STS and CMS data facilitates studying long-term outcomes and costs of cardiothoracic surgery.

5 Article Development of a clinical registry-based 30-day readmission measure for coronary artery bypass grafting surgery. 2014

Shahian, David M / He, Xia / O'Brien, Sean M / Grover, Frederick L / Jacobs, Jeffrey P / Edwards, Fred H / Welke, Karl F / Suter, Lisa G / Drye, Elizabeth / Shewan, Cynthia M / Han, Lein / Peterson, Eric. ·From the Massachusetts General Hospital and Harvard Medical School, Boston, MA (D.M.S.) · Duke Clinical Research Institute, Durham, NC (X.H., S.M.O., E.P.) · University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, CO, and Denver Department of Veterans Affairs Medical Center, Denver, CO (F.L.G.) · All Children's Hospital, John Hopkins University, Saint Petersburg, FL (J.P.J.) · University of Florida College of Medicine, Jacksonville, FL (F.H.E.) · Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, IL (K.F.W.) · Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE) and Yale School of Medicine, New Haven, CT (L.G.S., E.D.) · Society of Thoracic Surgeons, Chicago, IL (C.M.S.) · and Centers for Medicare and Medicaid Services, Baltimore, MD (L.H.). ·Circulation · Pubmed #24916208.

ABSTRACT: BACKGROUND: Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higher-than-expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data. METHODS AND RESULTS: We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008-2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records. Among 265 434 eligible Medicare records, 226 960 (86%) were successfully linked to Society of Thoracic Surgeons records; 162 572 (61%) isolated coronary artery bypass grafting admissions constituted the study cohort. Logistic regression was used to identify readmission risk factors; hierarchical regression models were then estimated. Risk-standardized readmission rates ranged from 12.6% to 23.6% (median, 16.8%) among 846 US hospitals with ≥30 eligible cases and ≥90% of eligible Centers for Medicare and Medicaid Services records linked to the Society of Thoracic Surgeons database. Readmission predictors (odds ratios [95% confidence interval]) included dialysis (2.02 [1.87-2.19]), severe chronic lung disease (1.58 [1.49-1.68]), creatinine (2.5 versus 1.0 or lower:1.49 [1.41-1.57]; 2.0 versus 1.0 or lower: 1.37 [1.32-1.43]), insulin-dependent diabetes mellitus (1.45 [1.39-1.51]), obesity in women (body surface area 2.2 versus 1.8: 1.44 [1.35-1.53]), female sex (1.38 [1.33-1.43]), immunosuppression (1.38 [1.28-1.49]), preoperative atrial fibrillation (1.36 [1.30-1.42]), age per 10-year increase (1.36 [1.33-1.39]), recent myocardial infarction (1.24 [1.08-1.42]), and low body surface area in men (1.22 [1.14-1.30]). C-statistic was 0.648. Fifty-two hospitals (6.1%) had readmission rates statistically better or worse than expected. CONCLUSIONS: A coronary artery bypass grafting surgery readmission measure suitable for public reporting was developed by using the national Society of Thoracic Surgeons clinical data linked to Medicare readmission claims.

6 Article Comparing off-pump and on-pump clinical outcomes and costs for diabetic cardiac surgery patients. 2014

Shroyer, A Laurie W / Hattler, Brack / Wagner, Todd H / Baltz, Janet H / Collins, Joseph F / Carr, Brendan M / Almassi, G Hossein / Quin, Jacquelyn A / Hawkins, Robert B / Kozora, Elizabeth / Bishawi, Muath / Ebrahimi, Ramin / Grover, Frederick L / Anonymous4810794. ·Northport VA Medical Center, Northport, New York; Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado. · Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado. · VA Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Health Research and Policy, Stanford University, Palo Alto, California. · Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado. · Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland. Electronic address: joseph.collins2@va.gov. · Northport VA Medical Center, Northport, New York. · Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin. · VA Boston Healthcare System, West Roxbury, Massachusetts. · Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Salem Veterans Affairs Medical Center, Salem, Virginia. · National Jewish Health, Denver, Colorado. · Greater Los Angeles VA Medical Center, Los Angeles, California. ·Ann Thorac Surg · Pubmed #24841548.

ABSTRACT: BACKGROUND: Observational studies have documented an off-pump over on-pump advantage for high-risk patients, including diabetic patients. Randomized trials have not confirmed this advantage. The VA Randomization On Versus Off Bypass (ROOBY) trial randomly assigned 2,203 coronary artery bypass graft surgery (CABG) patients at 18 sites to either on-pump (n=1,099) or off-pump (n=1,104) procedures. An a priori ROOBY aim was to evaluate treatment impact on diabetic patients. METHODS: Actively treated diabetic patients (n=835, receiving oral hypoglycemic or insulin medications) received off-pump CABG (n=402) or on-pump CABG (n=433). The primary ROOBY trial endpoints were a short-term composite (30-day operative death or major complications) and a 1-year composite (death, nonfatal acute myocardial infarction, or repeat revascularization). Secondary ROOBY endpoints included 1-year all-cause death, 1-year graft patency, 1-year changes from baseline in neurocognitive status and health-related quality of life, and costs. RESULTS: Diabetic patients' risk factors at baseline were balanced across treatments. For diabetic patients, the primary short-term composite outcome rate showed a worse trend for off-pump (8.0%) than on-pump (3.9%, p=0.013), with no difference in the 1-year primary composite outcome or 1-year death rate. One-year patency was 83.1% off-pump versus 88.4% on-pump (p=0.004). No differences were found in neurocognitive, health-related quality of life, discharge cost, and 1-year cumulative cost. CONCLUSIONS: Concordant with the ROOBY trial's overall findings, off-pump CABG yielded no advantage over on-pump CABG for actively treated diabetic patients. The 1-year graft patency was lower and the short-term composite trended higher for off-pump CABG, with no other significant outcome or cost differences.

7 Article On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial. 2013

Wagner, Todd H / Hattler, Brack / Bishawi, Muath / Baltz, Janet H / Collins, Joseph F / Quin, Jacquelyn A / Grover, Frederick L / Shroyer, A Laurie W / Anonymous180766. ·VA Palo Alto Health Economics Resource Center, Menlo Park, California 94025, USA. todd.wagner@va.gov ·Ann Thorac Surg · Pubmed #23916805.

ABSTRACT: BACKGROUND: Questions have been raised about the costs and outcomes for patients receiving on-pump and off-pump coronary artery bypass graft surgery. As part of the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was performed to compare on-pump versus off-pump patients' quality-adjusted life-years and costs at 1 year. METHODS: One-year outcomes and costs (standardized to 2010 dollars) were estimated in multivariate regression models, controlling for site and baseline patient factors. The 1-year incremental cost-effectiveness analysis ratio with 95% confidence intervals was calculated using bootstrapping. RESULTS: Eighteen centers randomly assigned 2,203 participants to on-pump (n=1,099) versus off-pump (n=1,104) coronary artery bypass graft surgery. Both groups' quality of life improved significantly after surgery (p<0.01) compared with baseline, but no differences were found between treatment groups. Adjusted cost of the index coronary artery bypass graft surgery hospitalization was $36,046 on-pump and $36,536 off-pump (p=0.16). At 1 year, on-pump adjusted cost was $56,023 versus $59,623 off-pump (p=0.046). Off-pump-to-on-pump conversions after first distal anastomosis (4.8%) had significantly higher 1-year costs. Excluding conversions, there were no significant differences between treatments for index hospitalization or 1-year total costs. CONCLUSIONS: At 1 year, off-pump coronary artery bypass graft surgery was more expensive than on-pump when late off-pump-to-on-pump conversions were included. Excluding late conversions, there was no difference in quality-adjusted life-years or costs. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00032630; http://clinicaltrials.gov/ct2/show/NCT00032630.

8 Article Chronic obstructive pulmonary disease impact upon outcomes: the veterans affairs randomized on/off bypass trial. 2013

Almassi, G Hossein / Shroyer, A Laurie / Collins, Joseph F / Hattler, Brack / Bishawi, Muath / Baltz, Janet H / Ebrahimi, Ramin / Grover, Frederick L. ·Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: halmassi@mcw.edu. · Northport Veterans Affairs Medical Center, Northport, New York; Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado. · Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland. · Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado. · Northport Veterans Affairs Medical Center, Northport, New York. · Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado. · Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California. ·Ann Thorac Surg · Pubmed #23915589.

ABSTRACT: BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at inherent risk for higher rates of adverse events after coronary artery bypass graft surgery (CABG). As compared with on-pump CABG (ONCAB), it has been suggested that beating heart or off-pump CABG (OPCAB) may differentially benefit high-risk COPD patients. METHODS: Intraoperative, 30-day and 1-year outcomes were compared for COPD patients randomized to OPCAB (n = 220) versus ONCAB (n = 238) within the Veterans Affairs' Randomized On/Off Bypass (ROOBY) trial. As COPD patients may more likely incur adverse post-CABG outcomes, a propensity analysis was performed comparing all ROOBY patients with COPD (n = 458) versus those without COPD (n = 1,745). RESULTS: For COPD patients, the baseline characteristics were similar between the 2 revascularization approaches. In these patients, the intraoperative complication rate was higher with OPCAB than ONCAB (21.9% vs 10.1%, respectively; p < 0.001), but there were no significant differences in the 30-day (7.3% vs 7.6%, p = 1.00) or 1-year composite outcome rates (9.5% vs 7.1%, p = 0.39) between the groups. Comparing the COPD patients with propensity-matched non-COPD patients, there was no difference in 1-year major adverse cardiovascular events (including the 1-year composite major adverse cardiac events (MACE) outcome, as well as the individual MACE outcomes for all cause death, acute myocardial infarction, or repeat revascularization). CONCLUSIONS: In COPD patients, there were more intraoperative complications and no differences in 30-day or 1-year outcomes with OPCAB as compared with ONCAB. Similar to patients without COPD, there was no benefit to using an OPCAB approach in COPD patients.

9 Article The current role of coronary artery bypass in diabetics with multivessel coronary disease. 2013

Grover, Frederick L / Mack, Michael J. ·Department of Surgery, University of Colorado School of Medicine, AuroraColorado 80045, USA. Frederick.grover@ucdenver.edu ·EuroIntervention · Pubmed #23793006.

ABSTRACT: -- No abstract --

10 Article Regional variation in patient risk factors and mortality after coronary artery bypass grafting. 2011

Quin, Jacquelyn A / Sheng, Shubin / O'Brien, Sean M / Welke, Karl F / Grover, Frederick L / Shroyer, A Laurie. ·VA Boston Healthcare System, West Roxbury, MA, USA. jacquelyn.quin@va.gov ·Ann Thorac Surg · Pubmed #21855853.

ABSTRACT: BACKGROUND: Geographic variations in patient risk factors and operative mortality after coronary artery bypass graft surgery have not been well studied. METHODS: Using The Society of Thoracic Surgeons National Cardiac Database, a retrospective cohort study was performed of patients undergoing isolated coronary artery bypass graft surgery from 2004 to 2007 (n = 504,608). Records were sorted into four major geographic regions (Northeast, Midwest, South, and West) and compared with respect to patient risk profiles and outcomes. Using marginal and hierarchical logistic regression, risk-adjusted operative mortality rates were compared across regions and variation assessed within regions, states and hospital referral regions. RESULTS: Patient risk profiles in the Northeast and West appeared similar, as did profiles in the Midwest and South. Risk-adjusted mortality rates were as follows: Northeast 1.63%, Midwest 2.01%, South 2.25%, and West 1.82%. Compared with the Northeast, mortality rates in the Midwest and South were higher, with the following odds ratios (95% confidence intervals): Midwest 1.26 (1.12 to 1.42), South 1.44 (1.27 to 1.62), and West 1.12 (0.98 to 1.28). Major geographic regions accounted for 16.5% of the variation observed in mortality rates; states and hospital referral regions accounted for 17.8% and 65.7%, respectively. CONCLUSIONS: Variations in absolute coronary artery bypass graft surgery mortality rates across large regions were subtle, although rates within the Northeast were comparatively lower. Most of the variation was seen at the hospital referral region level. Given that geographic location has not been routinely incorporated into statistical risk model predictions, additional research appears warranted to identify regional "best care" practices and to advance nationwide improvements in cardiac surgical patient outcomes.

11 Article Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial. 2011

Zenati, Marco A / Shroyer, A Laurie / Collins, Joseph F / Hattler, Brack / Ota, Takeyoshi / Almassi, G Hossein / Amidi, Morteza / Novitzky, Dimitri / Grover, Frederick L / Sonel, Ali F. ·Veterans Affairs Boston Healthcare System, West Roxbury, MA 02132, USA. Marco_Zenati@hms.harvard.edu ·J Thorac Cardiovasc Surg · Pubmed #21130476.

ABSTRACT: OBJECTIVE: In the Randomized On/Off Bypass (ROOBY) Trial, the efficacy of on-pump versus off-pump coronary artery bypass grafting was evaluated. This ROOBY Trial planned subanalysis compared the effects on postbypass patient clinical outcomes and graft patency of endoscopic vein harvesting and open vein harvesting. METHODS: From April 2003 to April 2007, the technique used for saphenous vein graft harvesting was recorded in 1471 cases. Of these, 894 patients (341 endoscopic harvest and 553 open harvest) also underwent coronary angiography 1 year after coronary artery bypass grafting. Univariate and multivariable analyses were used to compare patient outcomes in the endoscopic and open groups. RESULTS: Preoperative patient characteristics were statistically similar between the endoscopic and open groups. Endoscopic vein harvest was used in 38% of the cases. There were no significant differences in both short-term and 1-year composite outcomes between the endoscopic and open groups. For patients with 1-year catheterization follow-up (n=894), the saphenous vein graft patency rate for the endoscopic group was lower than that in the open harvest group (74.5% vs 85.2%, P<.0001), and the repeat revascularization rate was significantly higher (6.7% vs 3.4%, P<.05). Multivariable regression documented no interaction effect between endoscopic approach and off-pump treatment. CONCLUSIONS: In the ROOBY Trial, endoscopic vein harvest was associated with lower 1-year saphenous vein graft patency and higher 1-year revascularization rates, independent of the use of off-pump or on-pump cardiac surgical approach.

12 Minor The challenges with interpreting cost-effectiveness data. 2013

Wagner, Todd H / Shroyer, Annie Laurie W / Hattler, Brack / Collins, Joseph F / Grover, Frederick L / Anonymous4350774. ·VA Palo Alto Health Economics Resource Center Menlo Park , CA , USA. ·Scand Cardiovasc J · Pubmed #24200227.

ABSTRACT: -- No abstract --