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The Journal of Thoracic and Cardiovascular Surgery, Vol 80, 876-887, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JW Kennedy, GC Kaiser, LD Fisher, C Maynard, JK Fritz, W Myers, JG Mudd, TJ Ryan and J Coggin
The Collaborative Study in Coronary Artery Surgery (CASS) is a large
multi-institutional study of the medical and surgical treatment of coronary
artery disease (CAD). Fifteen cooperating institutes have carried out
isolated coronary artery bypass grafting (CABG) on 6,176 patients from
August, 1975, through December, 1978. The operative mortality (OM) was
2.3%. In an effort to better understand the clinical and angiographic
characteristics predictive of OM, we have done a multivariate discriminant
analysis of variables associated with OM. Numerous clinical and
angiographic variables were selected from the CASS data file and evaluated
in a univariate manner for their relationship to OM. Twenty of these
variables were then selected for multivariate discriminant analysis.
Clinical variables of most predictive value were age, female sex, increased
heart size, and congestive heart failure (CHF). Angiographic variables of
importance included left ventricular wall motion abnormalities, and left
main coronary disease (LMCD). The priority of operation (elective, urgent,
or emergent) was also associated with OM. Six variables that contained the
most predictive information were selected by discriminant analysis for a
group of 6,176 patients who had isolated bypass operations. In descending
order of importance they were age, left main coronary artery stenosis
greater than or equal to 90%, female sex, left ventricular wall motion
score, left ventricular end-diastolic pressure (LVEDP), and rales. Five
other groups or subgroups of patients were also analyzed in a similar
manner. There is a strong association of OM with advanced age, female sex,
and variables associated with left ventricular dysfunction. The risk of OM
for an individual patient may be estimated with the use of these clinical
and angiographic characteristics.
ARTICLES
Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS)
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