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Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis

2019; Elsevier BV; Volume: 160; Issue: 1 Linguagem: Inglês

10.1016/j.jtcvs.2019.07.086

1097-685X

Alexios S. Antonopoulos, Ayodele Odutayo, Evangelos K. Oikonomou, Marialena Trivella, Mario Petrou, Gary S. Collins, Charalambos Antoniades, Ioannis Akoumianakis, Keith M. Channon, L Herdman, Marios Margaritis, Stefan Neubauer, Sheena Thomas, Stephen E. Fremes, Reena Karkhanis, Jeffrey J. Rade, Toshihiro Fukui, Hidefumi Nishida, Shuichiro Takanashi, Ho Young Hwang, Ki‐Bong Kim, Luigi Mannacio, Vito Mannacio, Jota Nakano, Louis Perrault, Attila Kardos, Hitoshi Okabayashi, Dimitris Tousoulis, Andrew Kelion, Nik Sabharwal, George Krasopoulos, Rana Sayeed, David P. Taggart,

Cardiac Valve Diseases and Treatments

ObjectivesEarly saphenous vein graft (SVG) occlusion is typically attributed to technical factors. We aimed at exploring clinical, anatomical, and operative factors associated with the risk of early SVG occlusion (within 12 months postsurgery).MethodsPublished literature in MEDLINE was searched for studies reporting the incidence of early SVG occlusion. Individual patient data (IPD) on early SVG occlusion were used from the SAFINOUS-CABG Consortium. A derivation (n = 1492 patients) and validation (n = 372 patients) cohort were used for model training (with 10-fold cross-validation) and external validation respectively.ResultsIn aggregate data meta-analysis (48 studies, 41,530 SVGs) the pooled estimate for early SVG occlusion was 11%. The developed IPD model for early SVG occlusion, which included clinical, anatomical, and operative characteristics (age, sex, dyslipidemia, diabetes mellitus, smoking, serum creatinine, endoscopic vein harvesting, use of complex grafts, grafted target vessel, and number of SVGs), had good performance in the derivation (c-index = 0.744; 95% confidence interval [CI], 0.701-0.774) and validation cohort (c-index = 0.734; 95% CI, 0.659-0.809). Based on this model. we constructed a simplified 12-variable risk score system (SAFINOUS score) with good performance for early SVG occlusion (c-index = 0.700, 95% CI, 0.684-0.716).ConclusionsFrom a large international IPD collaboration, we developed a novel risk score to assess the individualized risk for early SVG occlusion. The SAFINOUS risk score could be used to identify patients that are more likely to benefit from aggressive treatment strategies.