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).
Highlights
Coronary artery bypass grafting (CABG) surgery is a widely used treatment for complex coronary artery disease (CAD) that improves patient outcomes and prognosis [1]
We developed a predictive risk score for saphenous vein graft SVG occlusion after CABG
The risk score developed in this study could guide treatment strategy by focusing on the likelihood of late SVG occlusion in CABG patient with high-risk factors, such as hyperuricemia and the use of ACEI/ARB or CCB, which are not currently addressed in treatment recommendations
Summary
Coronary artery bypass grafting (CABG) surgery is a widely used treatment for complex coronary artery disease (CAD) that improves patient outcomes and prognosis [1]. Studies have shown that the myocardial ischemic recurrence at 1 and 10 years after CABG are 17 and 63%, respectively [2, 3]. Saphenous vein is the most widely used vascular conduit for CABG [5]; the estimated rate of occlusion is as high as 42% at a mean follow-up of 7.5 years [6]. The patency of saphenous vein graft (SVG) has been assessed in several studies [7]. Late occlusion is due to development of atherosclerosis, which affects long-term clinical outcomes [10]; the treatment is more difficult compared to early occlusion, the specific risk factors for late SVG occlusion remain unclear. There is no precise scoring model for late SVG occlusion
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