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To the Editor: Dr Mangano and colleagues¹ investigated the potential long-term effects of aprotinin use following CABG surgery. It appears that 2 important determinants of long-term CABG outcomes were not included in these analyses.

First, the extent of underlying coronary disease (1-, 2- or 3-vessel coronary disease; presence or absence of left main trunk disease) was not discussed.

Second, in a multicenter multinational study, the grafting approaches used during surgery may have varied across sites. This includes completeness of revascularization, use of internal thoracic artery grafting, and arterial vs vein grafting, variables that are associated with long-term CABG outcomes.^2-3

We believe that these factors should have been included either in the multivariate Cox regression analysis or in the construction of the propensity model. Although this 45-covariate propensity model was used in their earlier study⁴ that focused on perioperative outcomes, it may not be appropriate for the current study unless these . . . [Full Text of this Article]

Robert H. Habib, PhD
robert_habib@mhsnr.org

Anoar Zacharias, MD
Division of Cardiovascular Surgery
St Vincent Mercy Medical Center
Toledo, Ohio

Thomas A. Schwann, MD
Department of Surgery
University of Toledo
College of Medicine
Toledo, Ohio

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