Appropriateness of Coronary Artery Bypass Graft Surgery Performed in Northern New England
Gerald T. O'Connor, PhD, ScD*,*,
Elaine M. Olmstead, BA ,
William C. Nugent, MD ,
Bruce J. Leavitt, MD||,
Robert A. Clough, MD¶,
Paul W. Weldner, MD#,
David C. Charlesworth, MD,
Kristine Chaisson, RN, BSN, MS,
Donato Sisto, MD ,
Edward R. Nowicki, MD, MS**,
Richard P. Cochran, MD||||,
David J. Malenka, MD for the Northern New England Cardiovascular Disease Study Group
* Department of Medicine and of Community and Family Medicine, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
|| Department of Surgery, Fletcher Allen Health Care, Burlington, Vermont
¶ Department of Surgery, Eastern Maine Medical Center, Bangor, Maine
# Department of Surgery, Maine Medical Center, Portland, Maine
** Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
Department of Surgery, Catholic Medical Center, Manchester, New Hampshire
Department of Surgery, Concord Hospital, Concord, New Hampshire
Department of Surgery, Portsmouth Regional Medical Center, Portsmouth, New Hampshire
|||| Department of Cardiothoracic Surgery, Central Maine Medical Center, Lewiston, Maine.
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Figure 1 2004 ACC/AHA Indications for Isolated CABG Surgery—Classification Tool
Directions for using the tool: 1) Place patient in highest clinical subgroup that describes the indication. 2) Within the selected subgroup, evaluate patient for class I, IIa, IIb, or III. ACC = American College of Cardiology; AHA = American Heart Association; CABG = coronary artery bypass graft; EF = ejection fraction; LAD = left anterior descending; LBBB = left bundle branch block; LM = left main; LV = left ventricular; MI = myocardial infarction; PCI = percutaneous coronary intervention; Prox.= proximal; PTCA = percutaneous transluminal coronary angioplasty; STEMI = ST-segment elevation myocardial infarction; 1VD = 1-vessel disease; 2VD = 2-vessel disease; 3VD = 3-vessel disease. Data from Eagle et al. (11).
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Figure 3 ACC/AHA Indications by Clinical Subgroup
Patients were classified using the 2004 ACC/AHA guidelines. Asymp = asymptomatic; LV func. = left ventricular function; NSTEMI = non–ST-segment elevation myocardial infarction; UA = unstable angina; other abbreviations as in Figure 1.
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