The following is a summary of “Risk Prediction After Coronary Artery Bypass Grafting Combined With Coronary Endarterectomy,” published in the June 2023 issue of Cardiology by Zhao et al.
Combining coronary endarterectomy (CE) with coronary artery bypass grafting (CABG) is used for complete revascularization, but studies indicate increased risk.
Researchers performed a retrospective study to develop a risk prediction model using a nomogram to estimate 1- and 3-year major adverse cardiovascular and cerebrovascular events (MACCE) risk after CABG + CE.
CABG + CE patients were retrospectively recruited from September 2008 to July 2022, and 32 characteristics were analyzed. Regression was used to develop a risk prediction nomogram. The primary outcome was MACCE, a combination of all-cause death, nonfatal heart attack, repeat bypass surgery, and stroke. A total of 570 patients with 601 CE targets were enrolled, including 41.4% left anterior descending, 43.9% right coronary artery, 6.8% left circumflex artery, and 8.0% diagonal branches/intermedius ramidus. The average age of the participants was 61 years, with 77.7% being men.
Four factors were identified as predictors of MACCE, including being over 65 years old (hazard ratio [HR] 2.12, 95% [CI] 1.38 to 3.25, P <0.001), having left main disease (HR 2.56, 95% CI 1.46 to 4.49, P= 0.001), having mitral regurgitation (≥mild, HR 1.91, 95% CI 1.01 to 3.65, P= 0.049), and having left anterior descending endarterectomy (HR 1.69, 95% CI 1.09 to 2.62, P= 0.018). A nomogram was developed to predict MACCE risk at 1 and 3 years, and the model showed good discrimination (C-index 0.68), calibration, and clinical usefulness.
The study concluded that the nomogram could predict the risk of MACCE 1 and 3 years after CABG + CE.