Nomogram for predicting major bleeding after off-pump coronary artery bypass grafting
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Jianqin Zhu1, Zhenjun Wu2, Guiming Huang3
1Department of Sleep Medicine, Ganzhou People's Hospital, Ganzhou, 341000, China.
Insights
This study developed a nomogram to predict major bleeding risk after off-pump coronary artery bypass grafting (CABG). The tool accurately identifies patients at higher risk, aiding clinical decisions and improving patient care.
Area of Science:
- Cardiovascular Surgery
- Medical Prediction Modeling
Background:
- Off-pump coronary artery bypass grafting (CABG) is a complex procedure.
- Major bleeding is a significant complication following CABG, impacting patient outcomes.
- Accurate prediction of bleeding risk is crucial for effective patient management.
Purpose of the Study:
- To develop and validate a novel nomogram for predicting major bleeding after off-pump CABG.
- To identify key predictors of major bleeding in patients undergoing off-pump CABG.
- To assess the clinical utility of the developed nomogram in surgical decision-making.
Main Methods:
- Retrospective analysis of 541 patients undergoing off-pump isolated primary CABG (January 2012 - December 2022).
- Multivariate analysis to identify independent predictors of major bleeding.
- Construction and validation of a predictive nomogram using ROC analysis and calibration.
- Decision curve analysis (DCA) to evaluate clinical benefit.
Main Results:
- Age, body mass index, hemoglobin, sodium, blood urea nitrogen, and operation time were identified as independent predictors of major bleeding.
- The developed nomogram demonstrated excellent discrimination and calibration.
- DCA indicated that using the nomogram for decision-making provides greater clinical benefit compared to treating all or no patients.
Conclusions:
- The developed nomogram accurately predicts major bleeding risk following off-pump CABG.
- This tool can aid in clinical decision-making, patient treatment strategies, and consultation services.
- The nomogram offers a valuable addition to the management of patients undergoing off-pump CABG.
Objective:
The purpose of this investigation is to develop a novel nomogram for predicting major bleeding following off-pump coronary artery bypass grafting (CABG).
Methods:
Between January 2012 and December 2022, 541 patients who underwent off-pump isolated primary CABG were included in a retrospective analysis. The primary outcome measure after off-pump CABG was major bleeding. Based on the outcomes of a multivariate analysis, nomograms were constructed. Using receiver operating characteristic analysis and calibration, the predictive accuracy of the nomograms was assessed. Using decision curve analysis (DCA), the clinical benefit of the nomograms was determined.
Results:
We categorized 399 and 142 patients in the "no major bleeding group" and "major bleeding group", respectively. Age (odds ratio (OR) 1.038; 95% confidence interval (CI) 1.009-1.068; p = 0.009), body mass index (OR 0.913; 95% CI 0.849-0.982; p = 0.014), hemoglobin (OR 0.958; 95% CI 0.945-0.971; p < 0.001), sodium (OR 0.873; 95% CI 0.807-0.945; p = 0.001), blood urea nitrogen (OR 1.198; 95% CI 1.073-1.338; p = 0.001), and operation time (OR 1.012; 95% CI 1.008-1.017; p < 0.001) were independent predictors for major bleeding after off-pump CABG. The model based on independent predictors exhibited excellent discrimination and calibration, with good agreement between actual and nomogram-estimated probabilities of generalization. DCA demonstrated that nomogram-assisted decisions have a greater positive benefit than treating all patients or none.
Conclusions:
The plotted nomogram accurately predicted major bleeding outcomes following off-pump CABG and may therefore contribute to clinical decision-making, patient treatment, and consultation services.
