Key result
Five-parameter risk score predicts SVGD in post-CABG patients with recurring ischemia with ~0.86 C-index.
Why the study?
Recurrence of ischemic symptoms after CABG is increasing and preventing or treating saphenous vein graft disease remains challenging, with few scores available to estimate risk after one year post CABG.
Can a five-parameter clinical risk score predict saphenous vein graft disease in patients with recurring ischemia >1 year after CABG?
Cross-Sectional (n=793)
Yes
Can a five-parameter clinical risk score predict saphenous vein graft disease in patients with recurring ischemia >1 year after CABG?
Effect estimate: C-index 0.86 (internal) and 0.82 (external)
A simple five-parameter risk score can accurately predict saphenous vein graft disease in patients presenting with recurrent ischemia more than one year after CABG.
BACKGROUND: The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE: We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS: This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION: A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.
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Li et al. (2022) conducted a cross-sectional in Saphenous vein graft disease (SVGD) (n=793). Five-parameter risk score was evaluated on Prediction of SVGD (symptomatic ⩾50% stenosis in at least one Saphenous vein graft) (C-index 0.86 (internal) and 0.82 (external)). A five-parameter risk score demonstrated good discrimination for predicting saphenous vein graft disease in patients with recurring ischemia >1 year post-CABG, with a C-index of 0.86 internally and 0.82 externally.
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