A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery?
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Published on: October 22, 2014
Nihat Soylemez1, Mehmet Balli2, Fatma Köksal3
1Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey. drnihats@yahoo.com.
Insights
A high CHA2DS2-Vasc-HS score can predict low Left Internal Mammary Artery (LIMA) flow during coronary artery bypass grafting (CABG). This score offers a reliable preoperative estimation of LIMA flow in severe coronary artery disease patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Medical Diagnostics
Background:
- The Left Internal Mammary Artery (LIMA) is crucial for coronary artery bypass grafting (CABG), offering superior patency rates, especially for the left anterior descending artery.
- The CHA2DS2-Vasc-HS scoring system is established for predicting coronary artery disease (CAD) severity in stable patients.
Purpose of the Study:
- To investigate the correlation between Left Internal Mammary Artery (LIMA) graft flow and the CHA2DS2-Vasc-HS score in patients undergoing CABG.
- To determine if the CHA2DS2-Vasc-HS score can predict suboptimal LIMA flow during surgery.
Main Methods:
- A cohort of 684 patients undergoing CABG was analyzed, excluding those with prior bypass, emergency surgery, Leriche syndrome, or severe pulmonary/subclavian disease.
- Patients were categorized into low LIMA flow and adequate LIMA flow groups based on intraoperative evaluation.
- The CHA2DS2-Vasc-HS score was calculated for all eligible patients.
Main Results:
- Older age, higher CHA2DS2-Vasc-HS scores, mild/moderate COPD, increased number of severely diseased vessels, and higher BMI were independent predictors of poor LIMA flow.
- A CHA2DS2-Vasc-HS score cutoff of >5.5 demonstrated high predictive accuracy (AUC: 0.938) for low LIMA flow, with 92.9% sensitivity and 83.4% specificity.
Conclusions:
- A high preoperative CHA2DS2-Vasc-HS score effectively predicts low intraoperative LIMA flow in CABG patients.
- The CHA2DS2-Vasc-HS score serves as a practical and dependable tool for preoperative assessment of LIMA flow in severe CAD cases.
Introduction:
Left internal mammary artery (LIMA) grafts should be used in patients undergoing CABG. No other procedure results in patency equivalent to that of the left anterior descending coronary artery (LAD)-LIMA bypass graft. The CHA2DS2-Vasc-HS scoring system can be used to successfully predict CAD severity in stable CAD patients. We aimed to investigate the relationship between LIMA flow and the CHA2DS2-Vasc-HS score.
Methods:
A total of 684 patients, who underwent CABG surgery, were included in this study. Previous history of bypass surgery, emergency operations, patients with Leriche syndrome and patients with severe obstructive pulmonary and subclavian artery disease were excluded from our study. Patients with a LIMA flow that was suitable for bypass grafting, as determined during the intraoperative evaluation, were included in the low LIMA flow group, and the CHA2DS2-Vasc-HS score was calculated for all patients.
Results:
Patients in the low LIMA flow group (Group 1) were older. The CHA2DS2-Vasc-HS score (P < 0.001), presence of mild or moderate COPD (P = 0.022), number of severely diseased vessels (P = 0.036), and BMI (P < 0.001) were independent predictors of poor LIMA flow. The cutoff value of the CHA2DS2-VASc-HS score for the prediction of poor LIMA flow was >5.5, with a sensitivity of 92.9% and specificity of 83.4% (AUC: 0.938, 95% Cl: 0.906 - 0.970, P < 0.001).
Conclusion:
A preoperative high CHA2DS2-Vasc-HS score can be used to predict low intraoperative LIMA flow. The CHA2DS2-Vasc-HS score is an easy-to-use and reliable estimation method and can be used as an additional preoperative of LIMA flow in patients undergoing CABG due to severe CAD.
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