Online Appendix for the following October 18 JACC article
TITLE: Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched AfricanAmerican versus Caucasian Patients: Evidence of a Late Survival—Medicaid Association
AUTHORS: Anoar Zacharias, MD, Divisions of Cardiovascular Surgery, St. Vincent Mercy
Medical Center, Toledo, Ohio, and Department of Surgery, College of Medicine, The Medical
University of Ohio, Toledo, Ohio, Thomas A. Schwann, MD, Divisions of Cardiovascular
Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio, and Department of Surgery, College
of Medicine, The Medical University of Ohio, Toledo, Ohio, Christopher J. Riordan, MD,
Divisions of Cardiovascular Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio, and
Department of Surgery, College of Medicine, The Medical University of Ohio, Toledo, Ohio,
Samuel J. Durham, MD, Divisions of Cardiovascular Surgery, St. Vincent Mercy Medical
Center, Toledo, Ohio, and Department of Surgery, College of Medicine, The Medical University
of Ohio, Toledo, Ohio, Aamir Shah, MD, Divisions of Cardiovascular Surgery, St. Vincent
Mercy Medical Center, Toledo, Ohio, and Department of Surgery, College of Medicine, The
Medical University of Ohio, Toledo, Ohio, Robert H. Habib, PhD, Divisions of Cardiovascular
Surgery, St. Vincent Mercy Medical Center, Toledo, Ohio, and Department of Medicine, College
of Medicine, The Medical University of Ohio, Toledo, Ohio
APPENDIX
Table S-1. Complementary Preoperative and Operative Data in Unmatched (All Patients) and
Matched AA and Caucasian CABG Patients
All Patients
Matched
Caucasian
AA
Caucasian
AA
Patients, n
6073
304
301
301
Age >65 yrs, %
46.1
38.5
37.9
38.9
Weight (kg)
86 ± 18
85 ± 17
85 ± 19
85 ± 17
Height (cm)
172 ± 10
170 ± 10
171 ± 10
170 ± 10
Small (BSA 1.6–1.8) , %
20.3
24.0
22.9
24.3
Very small (BSA <1.6), %
3.7
4.3
5.3
4.3
29.0 ± 5.4
29.0 ± 5.6
29.1 ± 5.3
29.4 ± 5.6
Moderate obesity BMI 35–40, %
9.0
9.2
7.3
9.3
Severe obesity BMI>40, %
4.0
4.9
4.3
5.0
Primary Medicaid, %
3.1
12.5
13.6
11.6
Secondary Medicaid, %
3.2
16.1
15.6
16.3
History of smoking, %
64.8
73.7
79.1
73.4
Family history of CAD, %
65.7
63.2
68.4
63.1
Dialysis-dependent, %
0.9
3.6
4.3
3.7
Cardiomegaly, %
11.0
14.1
10.6
14.0
Angina (any), %
92.1
93.1
93.7
93.0
Single-vessel disease, %
5.2
4.6
4.7
4.3
EF available, %
91.5
95.1
92.4
95.0
NYHA functional class I, %
3.7
4.6
2.7
4.3
NYHA functional class II, %
11.9
9.9
10.3
9.6
Digitalis, %
8.1
6.9
7.0
7.0
Nitrates-IV, %
28.3
25.7
30.6
25.6
Anticoagulants, %
36.0
35.5
38.5
35.5
Diuretics, %
21.7
26.0
24.6
25.9
Inotropes, %
2.1
3.9
3.0
3.7
Steroids, %
2.2
1.6
2.0
1.7
Aspirin, %
63.1
63.5
68.1
63.1
42.0
0.93 ± 0.39
0.33 ± 0.62
38.8
0.90 ± 0.37
0.35 ± 0.64
34.6
0.9 ± 0.4
0.3 ± 0.6
38.9
0.9 ± 0.4
0.3 ± 0.6
2
BMI (kg/m )
Preoperative medications
Operative data
Elective, %
IMA grafts
Radial grafts
Vein only, %
8.9
9.2
7.6
9.3
Vein used, %
88.2
87.8
88.7
88.0
Arterial only, %
11.8
12.2
11.3
12.0
RIMA, %
Both IMA, %
3.8
2.5
2.3
1.3
2.3
2.0
2.3
1.3
AA propensity score (P)*
0.045 ± 0.048
0.107 ± 0.107
0.103 ± 0.099
0.103 ± 0.099
Reoperation (cardiac), %
1.4
0.7
3.0
0.7
Reoperation (non-cardiac), %
3.0
2.6
5.3
2.7
Urinary tract infection, %
0.9
0.7
0.0
0.7
Continuous coma >4 h, %
0.6
0.0
0.7
0.0
Year of CABG†
7.0 ± 3.3
8.0 ± 3.4
7.6 ± 3.2
8.0 ± 3.4
Follow-up days
2,214 ± 1,246
1,815 ± 1,229
1,948 ± 1,174
1,828 ± 1,228
19.3
22.0
22.9
21.9
Perioperative data
Dead, %
*AA propensity score is based on AA = 1 Caucasian = 0 assumption (P = parsimonious); †Year of CABG varied
between 1 (1991 patients) and 13 (2003 patients). Categorical data are shown as % of patients and were compared
by Chi square test. Continuous data are provided as mean ± standard deviation and were compared by t-test or rank
sum test. NS = p > 0.2.
BMI = body mass index; BSA = body surface area; CAD = coronary artery disease; CV = cardiovascular; IABP
= intra-aortic balloon pump; IMA = internal mammary artery; LIMA/RIMA = left/right IMA; LOS = length of stay;
MI = myocardial infarction.
Table S-2. Multivariate Predictors of Operative Mortality Derived by Logistic Regression
Applied in All 6,377 Patients
Variable
Difficulty to wean off CPB
Emergency CABG
Age (per 10 yr increments)
Preoperative renal failure
Small size
BSA >1.90 m2
Small (BSA 1.7–1.9 m2)
Very small (BSA <1.7 m2)
Congestive heart failure
Cerebrovascular disease
Preoperative myocardial infarction
Redo CABG
Morbid obesity (BMI >35 kg/m2)
Wald (2)
57.0
39.3
34.5
20.4
16.2
Ref
7.8
13.9
14.1
14.1
6.7
5.8
5.7
p Value
0.000
0.000
0.000
0.000
0.000
0.005
0.000
0.000
0.000
0.001
0.016
0.017
OR
4.89
3.86
1.58
3.71
95% CI
3.24–7.38
2.53–5.89
1.38–1.78
2.19–6.29
1.00
1.75
2.44
2.09
1.94
1.65
1.95
1.87
1.18–2.60
1.53–3.91
1.43–3.07
1.37–2.74
1.13–2.40
1.13–3.36
1.12–3.12
Hosmer and Lemeshow goodness of fit statistic: 2 = 8.17; p = 0.417. AUC (ROC) = area under curve (receiver
operator-characteristic) = 0.83.
BMI = body mass index; BSA = body surface area; CI = confidence interval; OR = odds ratio.
Kaplan-Meier Analysis: All Patients
1.0
Older (>65 yrs)
0.9
0.9
0.8
0.8
Black
(117)
0.7
0.7
White
(2797)
0.6
0.6
P (Log Rank) = 0.050
P (Breslow) = 0.012
0.5
1.0
Cumulative Survival (Fraction)
Cumulative Survival (Fraction)
1.0
0.5
0
1
2
3
4
5
6
7
8
9
10
11
1.0
Young (<65 yrs)
0.9
0.9
0.8
0.8
0.7
0.7
0.6
0.6
P (Log Rank) = 0.019
P (Breslow) = 0.028
0.5
12
0.5
0
1
2
3
Years after CABG
Women
0.9
0.9
Black
(140)
0.8
0.8
White
(1811)
0.7
0.7
0.6
0.6
P (Log Rank) = 0.22
P (Breslow) = 0.25
0.5
0.5
2
3
4
5
6
7
8
5
6
7
8
9
10
11
12
9
10
11
12
1.0
Cumulative Survival (Fraction)
Cumulative Survival (Fraction)
1.0
1
4
Years after CABG
1.0
0
White
(3276)
Black
(187)
1.0
Men
0.9
0.9
White
(4262)
Black
(164)
0.8
0.8
0.7
0.7
0.6
0.6
P (Log Rank) = 0.033
P (Breslow) = 0.011
0.5
0.5
0
Years after CABG
1
2
3
4
5
6
7
8
Years after CABG
Figure S-1.
9
10
11
12
Kaplan-Meier Analysis: Matched Patients
1.0
1.0
Propensity-Adjusted
(Non-Parsimonious)
0.9
0.9
0.8
0.8
Caucasian
0.7
0.7
AA
0.6
HR (95% C.I.) = 1.16 (0.90-1.51)
0.6
P = 0.249
0.5
0.5
0
1
2
3
4
5
6
7
8
9
10
11
Cumulative Survival (Fraction)
Cumulative Survival (Fraction)
Cox Regression Analysis: All Patients
1.0
1.0
Non-Parsimonious Model
0.9
0.9
0.8
0.8
AA: (296)
Caucasian: (296)
0.7
0.7
0.6
0.6
HR (95% C.I.) = 1.09 (0.77-1.54)
P (Log Rank) = 0.62
0.5
12
0.5
0
Years after CABG
1
2
3
4
5
6
7
8
Years after CABG
Figure S-2.
9
10
11
12