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Risk Score for Long-Term Survival and Major Adverse Cardiovascular and Cerebrovascular Events After Coronary Artery
Aleksander Dokollari1, Fabrizio Rosati2, Claudio Muneretto2
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
New risk scores predict long-term survival and major adverse cardiovascular and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG). These scores, including ethnicity, offer good discrimination for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Public Health
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for managing cardiovascular disease.
- Predicting long-term survival and major adverse cardiovascular and cerebrovascular events (MACCEs) after CABG is essential for patient management and resource allocation.
- Existing risk stratification models may not fully capture all relevant predictors or perform optimally across diverse populations.
Purpose of the Study:
- To develop and validate novel risk scoring models for predicting long-term all-cause mortality and MACCEs following isolated CABG.
- To identify key preoperative predictors of adverse outcomes, including demographic factors.
- To assess the performance of these models through internal and external validation.
Main Methods:
- A retrospective analysis of 4,821 patients undergoing isolated CABG between January 2005 and July 2021 was conducted.
- Double-selection logit least absolute shrinkage and selection operator with adaptive selection was used for variable selection.
- Model performance was evaluated using calibration, accuracy, and area under the curve (AUC) via bootstrap cross-validation and external validation with 665 patients.
Main Results:
- Preoperative risk factors were identified as significant predictors for both all-cause mortality and MACCEs.
- African-American ethnicity emerged as a significant predictor for MACCEs post-CABG.
- Internal validation showed AUCs for mortality ranging from 79.1% to 81.3% and for MACCEs from 72.5% to 75% across 1-5 years.
- External validation yielded AUCs above 70% for both outcomes, demonstrating generalizability.
Conclusions:
- The developed Advanced (AD) Coronary Risk Score effectively predicts long-term mortality and MACCEs after isolated CABG.
- The models demonstrate good discrimination and calibration, supported by robust internal and external validation.
- Incorporating factors like ethnicity enhances the accuracy of risk prediction in CABG patients.
Abstract:
To develop risk scoring models predicting long-term survival and major adverse cardiovascular and cerebrovascular events (MACCEs), including myocardial infarction and stroke after coronary artery bypass grafting (CABG). All 4,821 consecutive patients who underwent isolated CABG at Lankenau between January 2005 and July 2021 were included. MACCE was defined as all-cause mortality + myocardial infarction + stroke. Variable selection for both outcomes was obtained using a double-selection logit least absolute shrinkage and selection operator with adaptive selection. Model performance was internally evaluated by calibration and accuracy using bootstrap cross-validation. Mortality and MACCEs were compared in patients split into 3 groups based on the predicted risk scores for all-cause mortality and MACCEs. An external validation of our database was performed with 665 patients from the University of Brescia, Italy. Preoperative risk predictors were found to be predictors for all-cause mortality and MACCEs. In addition, being of African-American ethnicity is a significant predictor for MACCEs after isolated CABG. The areas under the curve (AUCs), which measures the discrimination of the models, were 80.4%, 79.1%, 81.3%, and 79.2% for mortality at 1, 2, 3, and 5 years follow-up. The AUCs for MACCEs were 75%, 72.5%, 73.8%, and 72.7% at 1, 2, 3, and 5 years follow-up. For external validation, the AUCs for all-cause mortality and MACCEs at 1, 2, 3, and 5 years were 73.7%, 70.8%, 68.7%, and 72.2% and 72.3%, 68.2%, 65.6%, and 69.6%, respectively. The Advanced (AD) Coronary Risk Score for All-Cause Mortality and MACCE provide good discrimination of long-term mortality and MACCEs after isolated CABG. External validation observed a more AUCs greater than 70%.
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