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Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery.Data Source: Hospital data on all publicly funded CABG in five European countries, 2007-2009 (106,149 patients).Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix. Segmented regression analysis to estimate a threshold.Findings: The 30-day in-hospital mortality rate was 3.0 percent overall, 5.2 percent (95 percent CI: 4.0-6.4) in low-volume hospitals, and 2.1 percent (95 percent CI: 1.8-2.3) in high-volume hospitals. There is a significant curvilinear relationship between volume and mortality, flatter above 415 cases per hospital per year.Conclusions: There is a clear relationship between hospital CABG volume and mortality in Europe, implying a "safe" threshold volume of 415 cases per year. [ABSTRACT FROM AUTHOR]

OBJECTIVES Progressive loss of calibration of the original EuroSCORE models has necessitated the introduction of the EuroSCORE II model. Poor model calibration has important implications for clinical decision-making and risk adjustment of governance analyses. The objective of this study was to explore the reasons for the calibration drift of the logistic EuroSCORE. METHODS Data from the Society for Cardiothoracic Surgery in Great Britain and Ireland database were analysed for procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011. The primary outcome was in-hospital mortality. EuroSCORE risk factors, overall model calibration and discrimination were assessed over time. RESULTS A total of 317 292 procedures were included. Over the study period, mean age at surgery increased from 64.6 to 67.2 years. The proportion of procedures that were isolated coronary artery bypass grafts decreased from 67.5 to 51.2%. In-hospital mortality fell from 4.1 to 2.8%, but the mean logistic EuroSCORE increased from 5.6 to 7.6%. The logistic EuroSCORE remained a good discriminant throughout the study period (area under the receiver-operating characteristic curve between 0.79 and 0.85), but calibration (observed-to-expected mortality ratio) fell from 0.76 to 0.37. Inadequate adjustment for decreasing baseline risk affected calibration considerably. DISCUSSIONS Patient risk factors and case-mix in adult cardiac surgery change dynamically over time. Models like the EuroSCORE that are developed using a ‘snapshot’ of data in time do not account for this and can subsequently lose calibration. It is therefore important to regularly revalidate clinical prediction models. [ABSTRACT FROM PUBLISHER]

Although the presentation of original research to learned societies is valuable, the target should be publication in a peer-reviewed journal. Therefore, the strength of a meeting may be assessed by the rate of the subsequent publication of papers from the presented abstracts. We conducted an analysis of abstracts presented at consecutive annual meetings of the Society for Cardiothoracic Surgery (SCTS) in Great Britain and Ireland over a 15-year period. Abstract books and other documentation from the 1993–2007 meetings were reviewed; abstracts from other major Cardiothoracic Surgery meetings held in 2007 were also reviewed. Medline was searched to identify the peer-reviewed publications arising from each work presented. For abstracts presented at SCTS in 2003–07, the factors potentially associated with publication were analysed by logistic regression. If no publications were identified, authors were contacted through a standardized email questionnaire to ascertain its status and reasons for non-publication. Over the 15-year period, 909 abstracts were presented at the SCTS meetings. The rate of publication rose from ∼30% in the mid-1990s to consistently >60% from recent meetings, with a high of 81.3% from 2006. However, in comparison with other Cardiothoracic Surgery meetings in 2007, the chance of subsequent publication from SCTS (66.7%) was lower than from the European Association for Cardio-Thoracic Surgery (75.0%), the American Association for Thoracic Surgery (83.9%) and The Society of Thoracic Surgeons (72.5%) meetings. For abstracts presented at the last five SCTS meetings, publication was most commonly in a speciality journal (56.3%) and the median time for publication was 15 months (range −24 to 63 months) with 14 papers published prior to presentation at the meeting. On regression analysis, the only factor associated with publication was the study design comparing randomized trials and systematic reviews with other types of study (P < 0.01). Of the 90 unpublished abstracts, 48 (53.3%) authors replied to an email questionnaire revealing that 41 (85.4%) were never submitted for publication. The most common reasons given were low priority (29.6%) and low likelihood of acceptance (24.1%). In recent years, the annual meeting of the Society has become a forum for the presentation of high-quality research that usually withstands peer-review, most commonly in a speciality journal. The rate of publication has increased to consistently >60%, although those that remain unpublished are generally never submitted. This compares favourably with national meetings of other surgical societies, although it is lower than other major cardiothoracic meetings which have an affiliated journal. At a time when it has been suggested that medical research in the UK is in decline, cardiothoracic surgery appears to be thriving. [ABSTRACT FROM PUBLISHER]

Objective: The original EuroSCORE models are poorly calibrated for predicting mortality in contemporary cardiac surgery. EuroSCORE II has been proposed as a new risk model. The objective of this study was to assess the performance of EuroSCORE II in UK cardiac surgery Design: A cross-sectional analysis of prospectively collected multi-centre clinical audit data, from the Society for Cardiothoracic Surgery in Great Britain and Ireland Database Setting: All NHS hospitals, and some UK private hospitals performing adult cardiac surgery Patients: 23 740 procedures at 41 hospitals between July 2010 and March 2011 Main outcome measures: The main outcome measure was in-hospital mortality. Model calibration (HosmereLemeshow test, calibration plot) and discrimination (area under receiver operating characteristic curve) were assessed in the overall cohort and clinically defined sub-groups Results: The mean age at procedure was 67.1 years (SD 11.8) and 27.7% were women. The overall mortality was 3.1% with a EuroSCORE II predicted mortality of 3.4%. Calibration was good overall but the model failed the HosmereLemeshow test (p¼0.003) mainly due to overprediction in the highest and lowest-risk patients. Calibration was poor for isolated coronary artery bypass graft surgery (HosmereLemeshow, p<0.001). The model had good discrimination overall (area under receiver operating characteristic curve 0.808, 95% CI 0.793 to 0.824) and in all clinical sub-groups analysed Conclusions: EuroSCORE II performs well overall in the UK and is an acceptable contemporary generic cardiac surgery risk model. However, the model is poorly calibrated for isolated coronary artery bypass graft surgery and in both the highest and lowest risk patients. Regular revalidation of EuroSCORE II will be needed to identify calibration drift or clinical inconsistencies, which commonly emerge in clinical prediction models [ABSTRACT FROM AUTHOR]

OBJECTIVES The Global Registry of Acute Coronary Events (GRACE) registry reported that the in-hospital risk of death from non-ST elevation myocardial infarction (NSTEMI) is 5%, with an 11% mortality by 6 months. Prospective Registry of Acute Ischaemic Syndromes in the UK demonstrated that the overall risk of death from NSTEMI over 4 years is 25%. In GRACE, while 28% of patients received percutaneous intervention, only 10% received coronary artery bypass graft (CABG). Results of urgent CABG surgery following NSTEMI are difficult to interpret as these often include patients who have had STEMIs and urgent surgery. With increasing multidisciplinary assessment of patients with acute coronary syndromes (ACS), accurate data collection on the outcome of such patients could inform correct revascularization strategy. METHODS Three hundred and forty-two consecutive patients who had undergone urgent CABG from April 2004 to April 2009 at a single institution were identified. The GRACE predicted mortality was calculated from hospital records and patients categorized into three groups based upon their predicted risk. Late survival data were obtained from the UK Office of National Statistics. RESULTS The GRACE score could be calculated in 270 patients with a confirmed diagnosis of NSTEMI. Of the 304 probable patients with NSTEMI, there were 5 in-hospital deaths (1.6%). Survival at 6 months was higher than GRACE predicted mortality in all groups. At 6 months the predicted versus observed mortality in the low-risk group was 4 versus 2% (P = 0.05), in the medium-risk group it was 12.5 versus 1.9% (P = 0.0001) and in the high-risk group it was 25 versus 20% (P = 0.45). CONCLUSIONS In-hospital CABG performed after NSTEMI is associated with a low-mortality risk and survival significantly better than that predicted by the GRACE score. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that certain black and Asian minority ethnic groups experience poorer outcomes from COVID-19, but these studies have not provided insight into potential reasons for this. We hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health-seeking behaviours and community demographics were considered, and that this might reflect a more aggressive disease course in these patients., Methods: Patients with confirmed SARS-CoV-2 infection requiring admission to University Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham, UK between 10 March 2020 and 17 April 2020 were included. Standardised admission ratio (SAR) and standardised mortality ratio (SMR) were calculated using observed COVID-19 admissions/deaths and 2011 census data. Adjusted HR for mortality was estimated using Cox proportional hazard model adjusting and propensity score matching., Results: All patients admitted to UHB with COVID-19 during the study period were included (2217 in total). 58% were male, 69.5% were white and the majority (80.2%) had comorbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger and have no comorbidities, but twice the prevalence of diabetes than white patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted and they were more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death, both by Cox regression (HR 1.4, 95% CI 1.2 to 1.8), after adjusting for age, sex, deprivation and comorbidities, and by propensity score matching, matching for the same factors but categorising ethnicity into South Asian or not (HR 1.3, 95% CI 1.0 to 1.6)., Conclusions: Those of South Asian ethnicity appear at risk of worse COVID-19 outcomes. Further studies need to establish the underlying mechanistic pathways., Competing Interests: Competing interests: SB reports funding support from the HDR-UK. KR reports funding support from the NIHR. ES reports funding support from HDR-UK, MRC, Wellcome Trust, NIHR and British Lung Foundation. KN reports funding from MRC, Wellcome Trust, NIHR, Vifor and AstraZeneca. AKD reports funding from HDR-UK, Wellcome Trust and Fight for Sight., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)