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Published on: November 19, 2019
A Novel Risk Scoring Tool to Predict Saphenous Vein Graft Occlusion After Cardiac Artery Bypass Graft Surgery
Yujing Cheng1, Xiaoteng Ma1, Xiaoli Liu1
1Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
Insights
A new risk score predicts saphenous vein graft (SVG) occlusion after coronary artery bypass grafting (CABG). This tool identifies patients at risk, aiding in better outcomes for CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Clinical Risk Prediction
Background:
- Coronary artery bypass grafting (CABG) success is limited by saphenous vein graft (SVG) occlusion.
- Identifying factors influencing SVG occlusion is crucial for improving patient prognosis.
- A validated predictive tool for SVG occlusion is needed.
Purpose of the Study:
- To develop and validate a predictive risk score for late SVG occlusion following CABG.
- To identify key clinical factors associated with SVG occlusion post-CABG.
Main Methods:
- Retrospective cohort study of 3,716 CABG patients (2,477 derivation, 1,239 validation).
- Cox proportional hazards regression analyzed baseline clinical data for impact on graft occlusion.
- A risk scoring tool was developed and validated using c-statistics and probability comparisons.
Main Results:
- Late SVG occlusion occurred in 25.8% of patients.
- Risk factors included female sex, diabetes, smoking, hyperuricemia, dyslipidemia, prior PCI, and number of SVG/lesion vessels.
- Protective factors were on-pump surgery and use of ACEI/ARB and CCB medications.
Conclusions:
- An 11-variable risk scoring tool for late SVG occlusion after CABG was successfully developed and validated.
- The tool demonstrated good discrimination with a c-statistic of 0.71 in the validation cohort.
- This easy-to-use score aids in estimating the risk of SVG occlusion, potentially improving patient management.
Abstract:
Objectives: Coronary artery bypass grafting (CABG) success is reduced by graft occlusion. Understanding factors associated with graft occlusion may improve patient outcomes. The aim of this study was to develop a predictive risk score for saphenous vein graft (SVG) occlusion after CABG. Methods: This retrospective cohort study enrolled 3,716 CABG patients from January 2012 to March 2013. The development cohort included 2,477 patients and the validation cohort included 1,239 patients. The baseline clinical data at index CABG was analyzed for their independent impact on graft occlusion in our study using Cox proportional hazards regression. The predictive risk scoring tool was weighted by beta coefficients from the final model. Concordance (c)-statistics and comparison of the predicted and observed probabilities of predicted risk were used for discrimination and calibration. Results: A total of 959 (25.8%) out of 3,716 patients developed at least one late SVG occlusion. Significant risk factors for occlusion were female sex [beta coefficients (β) = 0.52], diabetes (β = 0.21), smoking (currently) (β = 0.32), hyperuricemia (β = 0.22), dyslipidemia (β = 0.52), prior percutaneous coronary intervention (PCI) (β = 0.21), a rising number of SVG (β = 0.12) and lesion vessels (β = 0.45). On-pump surgery (β = -0.46) and the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (β = -0.59) and calcium channel blockers (CCB) (β = -0.23) were protective factors. The risk scoring tool with 11 variables was developed from the derivation cohort, which delineated each patient into risk quartiles. The c-statistic for this model was 0.71 in the validation cohort. Conclusions: An easy-to-use risk scoring tool which included female sex, diabetes, smoking, hyperuricemia, dyslipidemia, prior PCI, a rising number of SVG and lesion vessels, on-pump surgery, the use of ACEI/ ARB and CCB was developed and validated. The scoring tool accurately estimated the risk of late SVG occlusion after CABG (c-statistic = 0.71).
