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Machine Learning-Enhanced TCAB Score for Predicting Postoperative Ischemic Stroke After CABG
Yingjian Pei1, Guitao Zhang1, Wenbo Li1
1Department of Neurology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Insights
A new Total Cerebral Atherosclerosis Burden (TCAB) score effectively predicts ischemic stroke after coronary artery bypass grafting. This tool aids in preoperative risk assessment and intraoperative protection strategies.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Postoperative acute ischemic stroke (AIS) is a significant risk following coronary artery bypass grafting (CABG).
- Predictive tools for AIS post-CABG are crucial for patient management and improving outcomes.
Purpose of the Study:
- To develop and validate a novel Total Cerebral Atherosclerosis Burden (TCAB) score.
- To assess the predictive capability of the TCAB score for AIS after CABG.
Main Methods:
- A prospective cohort of 909 patients undergoing CABG was enrolled.
- The TCAB score was calculated by quantifying stenosis severity across intracranial and extracranial arteries.
- Multivariable logistic regression and gradient boosting machine models were employed to evaluate TCAB's association with ischemic stroke and major adverse cardiovascular and cerebrovascular events.
Main Results:
- Patients with in-hospital AIS had a significantly higher mean TCAB score (8 vs. 2, P < 0.001).
- A TCAB score >3 predicted in-hospital AIS with an AUC of 0.756.
- Higher TCAB scores were independently associated with increased risk of in-hospital AIS, 1-year AIS, and 1-year MACE, with gradient boosting models showing strong predictive ability (AUCs ranging from 0.7475 to 0.8736).
Conclusions:
- The TCAB score, particularly when enhanced by machine learning, demonstrates robust predictive power for short-term and 1-year cerebrovascular and cardiovascular events post-CABG.
- The TCAB score serves as a practical tool for guiding preoperative revascularization decisions and intraoperative embolic protection strategies.
Background:
Postoperative acute ischemic stroke remains a critical complication of coronary artery bypass grafting. This study aimed to develop a novel Total Cerebral Atherosclerosis Burden (TCAB) score for predicting the risk of AIS post-coronary artery bypass grafting.
Methods:
A prospective cohort of patients undergoing coronary artery bypass grafting was enrolled. The TCAB score was calculated by summing stenosis severity grades (0: <50%, 1: 50-69%, 2: 70-99%, 3: 100%) across all intracranial and extracranial artery segments. Primary outcome was in-hospital ischemic stroke. Multivariable logistic regression models adjusted for key clinical covariates were used to evaluate the association between TCAB and clinical outcomes.
Results:
Among 909 included patients, the mean TCAB score was significantly higher in patients with in-hospital ischemic stroke compared with those without (8 versus 2, P < 0.001). A TCAB score >3 predicted in-hospital ischemic stroke with an area under the curve of 0.756. Across all 3 multivariable models, higher TCAB scores remained independently associated with in-hospital ischemic stroke (Model 3: odds ratio [OR]=1.089, P=0.011), 1-year ischemic stroke (OR=1.093, P=0.011), and 1-year major adverse cardiovascular and cerebrovascular events (OR=1.068, P=0.020). The gradient boosting machine achieved the most stable predictive ability (area under the curve=0.8736 for in-hospital ischemic stroke; 0.8575 for 1-year ischemic stroke; 0.7475 for 1-year major adverse cardiovascular and cerebrovascular events).
Conclusions:
The TCAB score, enhanced by machine learning, effectively predicted in-hospital ischemic stroke, 1-year ischemic stroke, and 1-year major adverse cardiovascular and cerebrovascular events post-coronary artery bypass grafting. It offers a practical tool for guiding preoperative revascularization and intraoperative embolic protection.
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