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J Thorac Cardiovasc Surg 2001;122:430-439
© 2001 The American Association for Thoracic Surgery

Statistics for the Rest of Us (STATS)

Breaking down barriers: Helpful breakthrough statistical methods you need to understand better

Eugene H. Blackstone, MD

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication May 8, 2001. Accepted for publication May 23, 2001. Address for reprints: Eugene H. Blackstone, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: blackse@ccf.org).

Three barriers to effective, helpful, and accurate analysis of clinical outcomes for which breakthrough technology has just emerged include: (1) general analysis of repeated follow-up measures, (2) treatment comparisons from nonrandomized clinical experiences, and (3) scientific risk factor identification. The three barriers have in common workarounds, that is, unsatisfactory and inadequate temporary, but simple, solutions in the absence of a real solution. Our expectations may be so low that we run the risk of preferring the workarounds for their simplicity rather than rejoicing that breakthrough has occurred! Therefore, the purpose of this article is to acquaint you with the breakthrough methods in a nontechnical fashion so that you may read reports more knowledgeably, interact with your statistical collaborators more closely, or encourage your statistician to consider these methods if they are applicable to your clinical research.

Barriers

Follow-up assessment
Clinical question:
How does aortic valve regurgitation progress after heart valve replacement with a bioprosthesis, and what factors influence that change?

Available data:
Aortic regurgitation grade (0 to 4+) by echocardiography at periodic clinic visits.

Simple workaround:
Tabulation of aortic regurgitation grade at latest clinic visit. Simple. But it does not answer the question!

Attempts have been made to depict the time-related change in graded outcomes after cardiac surgery, but the display appears complex at first glance. Even those attempts used the status only at last follow-up, not the status assessed periodically across time.Go Go 1,2

Clinical question:
How do pressure gradients across bioprostheses progress with time?

Available data:
Echocardiographic estimates of pressure gradient at irregular clinic visits.

Simple workaround:
Lacking methods to analyze serial echocardiographic data, we simply provide a global mean value. We may go a bit further and group the measurements into a few time intervals, then average all values within those intervals, perhaps stratified by prosthesis size.

Simple, but just as in the case of repeated assessment of functional status, the workaround does not . . . [Full Text of this Article]




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 Eur. J. Cardiothorac. Surg.Home page
L. R. Souza, P. M. A. Pomerantzeff, C. M. de Almeida Brandao, L. F. Cardoso, L. R. V. Carrillo, L. F. P. Moreira, M. Grinberg, and S. A. de Oliveira
Late evolution of mitral commissurotomy in patients with low echocardiographic score
Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 640 - 645.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
E. R. Nowicki, N. J. O. Birkmeyer, R. W. Weintraub, B. J. Leavitt, J. H. Sanders, L. J. Dacey, R. A. Clough, R. D. Quinn, D. C. Charlesworth, D. A. Sisto, et al.
Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in Northern New England
Ann. Thorac. Surg., June 1, 2004; 77(6): 1966 - 1977.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. A. Quader, P. M. McCarthy, A. M. Gillinov, J. M. Alster, D. M. Cosgrove III, B. W. Lytle, and E. H. Blackstone
Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting?
Ann. Thorac. Surg., May 1, 2004; 77(5): 1514 - 1524.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. F. Sabik, H. Nemeh, B. W. Lytle, E. H. Blackstone, A. M. Gillinov, J. Rajeswaran, and D. M. Cosgrove
Cannulation of the axillary artery with a side graft reduces morbidity
Ann. Thorac. Surg., April 1, 2004; 77(4): 1315 - 1320.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. F. Legare, K. J. Buth, J. A. Sullivan, and G. M. Hirsch
Composite arterial grafts versus conventional grafting for coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 160 - 166.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. F. Sabik III, B. W. Lytle, E. H. Blackstone, M. Khan, P. L. Houghtaling, and D. M. Cosgrove
Does competitive flow reduce internal thoracic artery graft patency?
Ann. Thorac. Surg., November 1, 2003; 76(5): 1490 - 1497.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
E. H. Blackstone, D. M. Cosgrove, W.R. E. Jamieson, N. J. Birkmeyer, J. H. Lemmer Jr, D. C. Miller, E. G. Butchart, G. Rizzoli, M. Yacoub, and A. Chai
Prosthesis size and long-term survival after aortic valve replacement
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 783 - 793.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
W. G. Williams, B. W. McCrindle, D. A. Ashburn, R. A. Jonas, C. Mavroudis, E. H. Blackstone, and the members of the Congenital Heart Surgeon's Soci
Outcomes of 829 neonates with complete transposition of the great arteries 12-17 years after repair
Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 1 - 10.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
E. Lim, Z. A. Ali, C. W. Barlow, C. H. Jackson, A.-R. Hosseinpour, J. C. Halstead, J. B. Barlow, and F. C. Wells
A simple model to predict coronary disease in patients undergoing operation for mitral regurgitation
Ann. Thorac. Surg., June 1, 2003; 75(6): 1820 - 1825.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D. H. Adams and F. Filsoufi
Another chapter in an enlarging book: Repair degenerative mitral valves
J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1197 - 1199.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
A. M. Gillinov, C. Faber, P. L. Houghtaling, E. H. Blackstone, B.-K. Lam, R. Diaz, B. W. Lytle, J. F. Sabik III, and D. M. Cosgrove III
Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease
J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1350 - 1362.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
A. M. Gillinov, E. H. Blackstone, D. M. Cosgrove III, J. White, P. Kerr, A. Marullo, P. M. McCarthy, and B. W. Lytle
Mitral valve repair with aortic valve replacement is superior to double valve replacement
J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1372 - 1387.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. M. Gillinov, E. H. Blackstone, J. M. Alster, J. M. Craver, W. A. Baumgartner, S. A. Brewster, L. H. Kleinman, and N. G. Smedira
The Carbomedics Top Hat supraannular aortic valve: a multicenter study
Ann. Thorac. Surg., April 1, 2003; 75(4): 1175 - 1180.
[Abstract] [Full Text] [PDF]

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 Card Surg AdultHome page
V. A. Ferraris and S. P. Ferraris
Risk Stratification and Comorbidity
Card. Surg. Adult, January 1, 2003; 2(2003): 187 - 224.
[Full Text]

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 Ann. Thorac. Surg.Home page
J. P. Umana, D. C. Miller, and R. S. Mitchell
What is the best treatment for patients with acute type B aortic dissections--medical, surgical, or endovascular stent-grafting?
Ann. Thorac. Surg., November 1, 2002; 74(5): S1840 - 1843.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
N. C. Patel, A. P. Deodhar, A. D. Grayson, D. M. Pullan, D. J.M. Keenan, R. Hasan, and B. M. Fabri
Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass
Ann. Thorac. Surg., August 1, 2002; 74(2): 400 - 406.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. K. Banbury, D. M. Cosgrove III, J. D. Thomas, E. H. Blackstone, J. Rajeswaran, J. E. Okies, and R. M. Frater
Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis
Ann. Thorac. Surg., May 1, 2002; 73(5): 1460 - 1465.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
E. H. Blackstone and T. W. Rice
Clinical-pathologic conference: Use and choice of statistical methods for the clinical study, ""Superficial adenocarcinoma of the esophagus""
J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1063 - 1076.
[Full Text] [PDF]


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