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Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease
Hao-ran Wang1, Zhe Zheng, Hui Xiong
1Research Center for Cardiac Regenerative Medicine of the Ministry of Health, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Existing risk models inaccurately predict major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing hybrid coronary revascularization. New models are needed to improve risk assessment for this complex procedure.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- Hybrid coronary revascularization combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- It offers an alternative revascularization strategy for coronary heart disease patients.
- Multivessel disease presents unique challenges for treatment selection.
Purpose of the Study:
- To evaluate the predictive accuracy of four established risk-stratification models for major adverse cardiac and cerebrovascular events (MACCE).
- To assess the SYNTAX score, EuroSCORE, SinoSCORE, and Global Risk Classification (GRC) in patients undergoing hybrid coronary revascularization.
- To determine the suitability of current models for risk assessment in this specific patient population.
Main Methods:
- Retrospective analysis of data from 120 patients undergoing hybrid coronary revascularization.
- Calculation of SYNTAX score, EuroSCORE, SinoSCORE, and GRC for each patient.
- Follow-up for 2.7 years to record incidences of MACCE (death, myocardial infarction, stroke, revascularization).
Main Results:
- During a mean 2.7-year follow-up, survival was high (99.17%) with no myocardial infarctions.
- The area under the curve (AUC) for predicting MACCE ranged from 0.57 to 0.65 for the evaluated models.
- Calibration tests indicated that the models were not well-calibrated for this patient group.
Conclusions:
- The SYNTAX score, EuroSCORE, SinoSCORE, and GRC demonstrated limited accuracy in predicting MACCE in patients with multivessel disease undergoing hybrid procedures.
- Current risk-stratification models require modification to enhance their predictive value for hybrid coronary revascularization.
- Further research is necessary to develop and validate improved risk assessment tools for this patient cohort.
Background:
The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization.
Methods:
The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification (GRC) calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization.
Results:
During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power (area under curve (AUC)) of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42 - 0.77), 0.65 (0.47 - 0.82), 0.57 (0.39 - 0.75) and 0.65 (0.46 - 0.83), respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 (P = 0.86), 5.39 (P = 0.37), 13.81 (P = 0.32) and 0.02 (P = 0.89), respectively.
Conclusions:
In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.