Tasbulak Omer, Sahin Anil
Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TUR.
Cureus. 2022 Mar 4;14(3):e22833. doi: 10.7759/cureus.22833. eCollection 2022 Mar.
Background and objective Graft patency is one of the major concerns after coronary artery bypass graft (CABG) surgery. The CHADS-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus (DM), stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category] score is a tool that was developed to predict the risk of thrombotic events in patients with atrial fibrillation (AF). In this study, we evaluated the use of the CHADS-VASc score as a simple tool for predicting graft failure (GF) among patients who underwent CABG surgery. Methods In this retrospective case-control study, a total of 280 patients were enrolled after applying the exclusion criteria. Angiograms were analyzed by using the QCA software system (Pie Medical Imaging, Maastricht, The Netherlands) for each patient. A graft was described as failed if it had 70% or more stenosis or was completely occluded. Patients were classified into two groups: group one included patients without GF (GF-N) and group two included patients with GF (GF-Y). Thereafter, the CHADS-VASc risk score was calculated for each patient. Results In our cohort, 136 patients had GF (GF-Y group) and 144 patients did not have GF (GF-N group). GF-N and GF-Y patients had their angiography performed 100.31 ± 8.04 and 103.49 ± 8.41 months after CABG, respectively. GF-Y group had a significantly higher rate of DM, hypertension, and heart failure with reduced ejection fraction (HFrEF). GF-Y group had higher CHADS(GF-N group: 1.47 ± 0.91 vs. GF-Y group: 2.57 ± 1.17, p=0.0001) and CHADS-VASc score (GF-N group: 2.80 ± 1.11 vs. GF-Y group: 4.15 ± 1.25, p=0.0001). Analyses showed that only CHADS-VASc was an independent predictor of GF while other parameters including DM, hypertension, HFrEF, creatinine, and CHADS were not found to be independent predictors of GF. A CHADS-VASc score of >3 predicted GF with a sensitivity of 65.44% and a specificity of 74.31%. Conclusions The CHADS-VASc score might be used as a feasible and simple method to predict the risk of GF after CABG surgery.
背景与目的 移植血管通畅是冠状动脉旁路移植术（CABG）后主要关注的问题之一。CHADS-VASc[充血性心力衰竭、高血压、年龄≥75岁、糖尿病（DM）、卒中或短暂性脑缺血发作（TIA）、血管疾病、年龄65至74岁、性别分类]评分是一种用于预测心房颤动（AF）患者血栓形成事件风险的工具。在本研究中，我们评估了CHADS-VASc评分作为预测接受CABG手术患者移植血管失败（GF）的一种简单工具的应用情况。方法 在这项回顾性病例对照研究中，应用排除标准后共纳入280例患者。使用QCA软件系统（荷兰马斯特里赫特的Pie Medical Imaging公司）对每位患者的血管造影进行分析。如果移植血管狭窄70%或以上或完全闭塞，则判定为失败。患者分为两组：第一组包括无GF的患者（GF-N组），第二组包括有GF的患者（GF-Y组）。此后，为每位患者计算CHADS-VASc风险评分。结果 在我们的队列中，136例患者有GF（GF-Y组），144例患者无GF（GF-N组）。GF-N组和GF-Y组患者分别在CABG术后100.31±8.04个月和103.49±8.41个月进行血管造影。GF-Y组的DM、高血压和射血分数降低的心力衰竭（HFrEF）发生率显著更高。GF-Y组的CHADS（GF-N组：1.47±0.91 vs. GF-Y组：2.57±1.17，p = 0.0001）和CHADS-VASc评分（GF-N组：2.80±1.11 vs. GF-Y组：4.15±1.25，p = 0.0001）更高。分析表明，只有CHADS-VASc是GF的独立预测因子，而包括DM、高血压、HFrEF、肌酐和CHADS在内的其他参数未被发现是GF的独立预测因子。CHADS-VASc评分>3预测GF的敏感性为65.44%，特异性为74.31%。结论 CHADS-VASc评分可能是预测CABG术后GF风险的一种可行且简单的方法。
