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Eur J Cardiothorac Surg 2003;23:710-714
© 2003 Elsevier Science NL
a German Heart Center Munich, Technical University of Munich, Lazarettstrasse 36, 80636 Munich, Germany
b Institute for Social Pediatrics and Adolescent Medicine, Pediatric Epidemiology, Ludwig-Maximilians University Munich, Munich, Germany
c Providence Health System, Portland, OR, USA
Received 3 October 2002; received in revised form 23 January 2003; accepted 27 January 2003.
* Corresponding author. Tel.: +49-170-3850296; fax: +49-89-12184113
e-mail: stefkaempchen{at}web.de
Objective: The standard method of analysing structural valve degeneration (SVD) of biological prostheses is the Kaplan–Meier method. In order to assess SVD with regard to competing risks (e.g. death particularly in elderly patients) cumulative incidence (actual analysis) was compared to Kaplan–Meier (actuarial analysis). Methods: We retrospectively analysed 257 patients older than 60 years, who underwent mitral valve replacement with different biological prostheses between 1974 and 2000. Reoperation-free survival was determined, both according to Kaplan–Meier and cumulative incidence analysis. Results: For the total group of patients older than 60 years, the 10- and 15-year freedom from reoperation was 79±5 and 55±8%, respectively, according to Kaplan–Meier and 90±2 and 83±3% according to cumulative incidence analysis. For patients older than 65 years of age (n=170), Kaplan–Meier analysis revealed 85±7% freedom from reoperation at 10 years vs. 94±3% according to cumulative incidence analysis. For those between 60 and 65 years of age (n=87), Kaplan–Meier freedom from reoperation was 76±7% at 10 years and 48±9% at 15 years vs. 86±4 and 75±5% according to cumulative incidence analysis. Conclusions: Kaplan–Meier analysis overestimates the 10- and 15-year risk of SVD compared to cumulative incidence analysis, thus underestimating the benefit of biological valve replacement. Cumulative incidence analysis may lead to a more complete evaluation of risk and benefit and thus better patient management.
Key Words: Actual analysis • Cumulative incidence • Competing risks • Valve replacement • Freedom from reoperation
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