Validating the SMART2 Score in a Racially Diverse High‐Risk Nationwide Cohort of Patients Receiving Coronary Artery Bypass Grafting
Key result
The SMART2 risk score demonstrated moderate discrimination (c-statistic 64) but underpredicted 5-year major adverse cardiovascular events (observed/expected ratio 1.45) in US veterans undergoing CABG.
Why the study?
The authors sought to test the potential of the Secondary Manifestations of Arterial Disease (SMART2) risk score for use in patients undergoing coronary artery bypass grafting.
Does the SMART2 risk score accurately predict 5-year major adverse cardiovascular events in a racially diverse cohort of patients undergoing coronary artery bypass grafting?
Population
27 443 US veterans undergoing isolated coronary artery bypass grafting
Design
External validation cohort study
Follow-up
5 years
Authors
Discussion
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Member takes
Overview
Suggests caution when using SMART2 for absolute risk estimation post-CABG.
Study Design
Type
Cohort (n=27,443)
Multicenter
Yes
Structured PICO
Does the SMART2 risk score accurately predict 5-year major adverse cardiovascular events in a racially diverse cohort of patients undergoing coronary artery bypass grafting?
P
Population
27,443 US veterans (mean age 65 years, 10% Black) undergoing isolated coronary artery bypass grafting between 2010 and 2019, evaluated for 5-year major adverse cardiovascular events.
E
Exposure
SMART2 risk score calculation
O
Outcome
5-year major adverse cardiovascular event (composite of cardiovascular mortality, myocardial infarction, and stroke)composite
Main Result
Effect estimate: c-statistic 64
The SMART2 risk score demonstrates acceptable discrimination but underpredicts absolute risk in patients undergoing CABG, yet remains useful for guiding secondary preventive pharmacotherapy.
Cite This Study
Deo et al. (2023) conducted a cohort in coronary artery bypass grafting (n=27,443). SMART2 risk score was evaluated on 5-year major adverse cardiovascular event (cardiovascular mortality+myocardial infarction+stroke) (c-statistic 64). The SMART2 risk score demonstrated moderate discrimination (c-statistic 64) but underpredicted 5-year major adverse cardiovascular events (observed/expected ratio 1.45) in US veterans undergoing CABG.