Li Xiao-Wei, Cui Zhuang, Xiao Jian-Yong, Gao Ming-Dong, Zhang Mei, Zhang Wen-Juan, Tian Feng-Shi, Song Yu, Liu Ying-Wu, Yao Zhu-Hua, Ma Jun, Liu Yin, Gao Jing
Tianjin Medical University, Tianjin, China.
Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.
Perfusion. 2023 May;38(4):843-852. doi: 10.1177/02676591221090588. Epub 2022 May 18.
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.
We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG.
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.
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.
近年来，冠状动脉旁路移植术（CABG）后缺血症状的复发率呈上升趋势。如何预防和治疗大隐静脉移植血管病变（SVGD，至少一条大隐静脉移植血管出现症状性狭窄≥50%）至今仍是一项临床挑战。不同时期的SVGD可能存在不同的发病机制。目前，用于评估CABG术后1年发生SVGD风险的可用评分较少。
我们试图开发并验证一种简单的预测性临床风险评分，用于评估CABG术后1年出现复发性缺血的SVGD风险。
这是一项横断面研究，结果在一个单独的队列中通过自抽样重抽样进行验证。基于来自606例CABG术后1年以上出现复发性缺血的连续患者的训练队列的回顾性数据，开发了一个列线图和风险评分系统。使用逻辑回归模型寻找预测因素并构建列线图。为了评估模型的普遍性，通过自抽样重抽样和对其他四家医院的187例连续患者进行的外部横断面研究对模型进行验证。在对主要队列的多变量分析中，原位病变血管数量、移植血管使用年限、复发性缺血类型、极低密度脂蛋白水平和左心室舒张末期直径是独立的预测因素。从列线图得出一个汇总风险评分，临界值为15。在内部和外部验证中，C指数分别为0.86和0.82，表明具有良好的区分度。SVGD概率的校准曲线显示实际观察结果与风险评分预测之间具有最佳一致性。
开发并验证了一种基于五个易获取变量的简单易用的风险评分系统，以预测CABG术后1年出现复发性缺血的患者发生SVGD的风险。该评分可能有助于为患者提供SVGD风险的个性化评估。
