Fifty patients who underwent aortocoronary saphenous-vein bypass-graft surgery were randomly assigned to one of three groups to determine the effects of antiplatelet or anticoagulant therapy on graft patency. Twenty-four patients served as controls; 13 patients received aspirin (325 mg three times a day) and dipyridamole (75 mg three times a day); and 13 patients received closely regulated warfarin therapy. Medications were begun on the third post-operative day. Six months after surgery, all patients underwent coronary angiography to assess graft patency. There were no statistically significant differences between groups in various clinical, hemodynamic and angios, 27 of 33 grafts (82 per cent) with aspirin and dipyridamole and 29 of 37 grafts (78 per cent) with warfarin (P less than 0.5), all patients had at least one patent graft. Postoperative treatment either with aspirin and dipyridamole or with warfarin failed to improve the patency of the grafts.

When I began planning this address 2 years ago, the plan was for the California Coronary Artery Bypass Graft Mortality Reporting Program (CCMRP) to release results publicly in 1999. For many reasons the release has been repeatedly postponed and has not yet occurred. The impact of the release and the reaction to the release was what I thought would bring maximum timeliness to my address, but that was not to be.The imminent release of statewide data for California, the experience with projects in New York, Pennsylvania, New Jersey, Northern New England, and Minnesota, and the proliferation of other statewide projects have stimulated me to review the history of these projects, assess where they are now, and look to the future, with both predictions and recommendations.I have tried to gain access to the information in the statewide reports by using the Internet. I think the Internet is the medium most used by our patients to find out what we do and how well we do it, and this use will continue to grow in the future. Therefore, it is important to know the present state of Internet information. New YorkThe New York State Department of Health developed the first physician-specific mortality reports ever published when it initiated the Cardiac Surgery Reporting System (CSRS) in 1991. 2 This project has been the I have been interested in data collection and analysis for many years. While at the Oregon Health Sciences University in the 1970s I was stimulated in this area. In Sacramento, in the early 1980s, our group began a thorough system of data collection and analysis, hiring a full-time data manager in 1983 and beginning the transition to the Society of Thoracic Surgeons (STS) database in 1991. In the early years we had a crude system of risk prediction. Each surgeon would assign a risk to each of his patients preoperatively at the morning meeting. We then analyzed the observed and predicted results as a method of quality assessment, and we published an article in 1987. 1 The Western Thoracic Surgical Association has had a long and proud record of supporting outcomes research and reporting. This has been part of several presidential addresses in the past. Members of this Association have served and are serving in important capacities in the STS database project.

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