Ruyun Jin, MD, Gary L. Grunkemeier, PhD, Albert Starr, MD

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Validation and Refinement of Mortality Risk Models for Heart Valve Surgery Ruyun Jin, MD, Gary L. Grunkemeier, PhD, Albert Starr, MD The Annals of Thoracic Surgery Volume 80, Issue 2, Pages 471-479 (August 2005) DOI: 10.1016/j.athoracsur.2005.02.066 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Comparison of Northern New England Cardiovascular Disease Study Group (NNE) and Providence Health System Cardiovascular Study Group (PHS) patient characteristics for aortic valve replacement (AVR). Listed are 11 variables which define the 18 risk factors for mortality in the NNE risk model for AVR. *NNE and PHS use slightly different definitions for these risk factors, see text. (CABG = coronary artery bypass graft; CAD = coronary artery disease; CHF = congestive heart failure; Cr = creatinine; E = emergent; NYHA = New York Heart Association functional class.) The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Comparison of Northern New England Cardiovascular Disease Study Group (NNE) and Providence Health System Cardiovascular Study Group (PHS) patient characteristics for mitral valve surgery (replacement or repair [MVRR]). Listed are 11 variables which define the 16 risk factors for mortality in the NNE risk model for MVRR. (CAD = coronary artery disease; CHF = congestive heart failure; Cr = creatinine; E = emergent; NYHA = New York Heart Association functional class.) The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Comparison of Northern New England Cardiovascular Disease Study Group (NNE) and Providence Health System Cardiovascular Study Group (PHS) multivariable odds ratios for aortic valve replacement (AVR). The odds ratios (with 95% confidence intervals) are given for each risk factor in the NNE risk model for AVR mortality. (BSA = body surface area; CABG = coronary artery bypass graft; CHF = congestive heart failure; Cr = creatinine; NYHA = New York Heart Association functional class.) The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Comparison of Northern New England Cardiovascular Disease Study Group (NNE) and Providence Health System Cardiovascular Study Group (PHS) for mitral valve surgery (MVRR). The odds ratios (with 95% confidence intervals) are given for each risk factor in the NNE risk model for MVRR mortality. (CAD = coronary artery disease; CHF = congestive heart failure; Cr = creatinine; NYHA = New York Heart Association functional class.) The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Hospital mortality by patient age. The height of the circles indicate the observed mortality for patients grouped by decade of age. The area of the circles is proportional to the number of patients in the group. The solid line shows the mortality predicted by using age as a continuous variable in a (univariate) logistic model (logistic equation). The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Plots of the cumulative sums (Cusum) of observed minus expected deaths, by patient age. The thicker gray line uses the risk predicted with age excluded from the model. The thinner black line uses the risk predicted by the full PHS model, with age included. The horizontal line is the line of identity, representing perfect agreement between observed and expected. The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Histogram of the logarithm of serum creatinine, showing observed values (gray bars; n = 3,492) and imputed values (black bars; n = 1428). The Annals of Thoracic Surgery 2005 80, 471-479DOI: (10.1016/j.athoracsur.2005.02.066) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions