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

Antonopoulos, Alexios S.; Odutayo, Ayodele; Oikonomou, Evangelos; Trivella, Marialena; Petrou, Mario; Collins, Gary S.; Antoniades, Charalambos

doi:10.1016/j.jtcvs.2019.07.086

Cited by 38 publications

(32 citation statements)

References 64 publications

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“…The β coefficient (β i ) of each category was determined by multiple logistic regression analysis (Table 3). In order to determine the weight of each category, the age was converted into a categorical variable, and the weight was assigned as the value of average age (22,23). In addition, for the other categorical variables such as gender, race, marital status, tumor stage, histologic grade, surgery, and chemotherapy, the weight of the reference category (W iRef ) was defined as 0 and the weight of the other categories (W ij ) were assigned as 1.…”

Section: Discussionmentioning

confidence: 99%

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Development and Validation of a Score for Screening Suicide of Patients With Neuroendocrine Neoplasms

Shang

Zechner

et al. 2021

Front. Psychiatry

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Background: If the diagnosis of neuroendocrine neoplasm (NEN) increases the risk of patients to commit suicide has not been investigated so far. Identifying NEN patients at risk to commit suicide is important to increase their life quality and life expectancy.Methods and findings: Cancer cases were extracted from the Surveillance, Epidemiology, and End Results program and were divided into the NEN and the non-NEN cohorts. Subsequently, the NEN patients were randomly split into a training data set and a validation data set. Analyzing the training data set, we developed a score for assessing the risk to commit suicide for patients with NEN. In addition, we validated the score using the validation data set and evaluated, if this score could also be applied to other cancer entities by using the test data set, a non-NEN cohort. The odds ratio (OR) of suicide between NEN and non-NEN patients was determined. Moreover, the performance of a score was evaluated by the receiver operating characteristic curve and the area under the curve (AUC). Compared to non-NEN, NEN significantly increased the risk of suicide to 1.8-fold (NEN vs. non-NEN; OR, 1.832; P < 0.001). In addition, we observed that age, gender, race, marital status, tumor stage, histologic grade, surgery, and chemotherapy were associated with suicide among NEN patients; and a synthesized score based on these factors could significantly distinguish suicide individuals from non-suicide individuals in the training data set (AUC, 0.829; P < 0.001) and in the validation data set (AUC, 0.735; P < 0.001). This score also had a good performance when it was assessed by the test data set (AUC, 0.690; P < 0.001). This demonstrates that the score might also be applicable to other cancer entities.Conclusions: This population-based study suggests that NEN patients have a higher risk of suicide than non-NEN patients. In addition, this study provided a score, which can identify NEN patients at high-risk of committing suicide. Thus, this score in combination with current screening and prevention strategies for suicide may improve life quality and life expectancy of NEN patients.

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Section: Discussionmentioning

confidence: 99%

“…the system, we defined B to reflect the decrease of risk when age has increased 10 years ( 22): B = −0.05 × 10 = −0.5. Finally, the score of each category was computed by β i × (W ij -W iRef )/B (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Score for Screening Suicide of Patients With Neuroendocrine Neoplasms

Shang

Zechner

et al. 2021

Front. Psychiatry

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“…They found, in a sample of the study group, that EVH was associated with a reduced graft patency (42% vs. 6%) although this was not related to an increase in angina, myocardial infarction or mortality (30). A recent patient-level data meta-analysis using only EVH from experienced centres identified that endoscopic harvest might even reduce the risk of graft failure (31).…”

Section: Evh Graft Patency and Clinical Outcomesmentioning

confidence: 99%

Endoscopic vein harvesting

Akowuah¹,

Burns²,

Zacharias³

et al. 2021

J Thorac Dis

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Coronary artery bypass grafting is the most common cardiac surgical procedure performed worldwide and the long saphenous vein the most common conduit for this. When performed as an open vein harvest (OVH), the incision on each leg can be up to 85cm long, making it the longest incision of any routine procedure. This confers a high degree of morbidity to the procedure. Endoscopic vein harvest (EVH) methods were popularised over two decades ago, demonstrating significant benefits over OVH in terms of leg wound complications including surgical site infections. They also appeared to hasten return to usual activities and wound healing and became popular particularly in North America. Subgroup analyses of two trials designed for other purposes created a period of uncertainty between 2009-2013 while the impact of endoscopic vein harvesting on vein graft patency and major adverse cardiac events was scrutinised. Large observational studies debunked the findings of increased mortality in the short-term, allowing practitioners and governing bodies to regain some confidence in the procedure. A well designed, adequately powered, randomised controlled trial published in 2019 also definitively demonstrated that there was no increase in death, myocardial infarction or repeat revascularisation with endoscopic vein harvest. Endoscopic vein harvest is a Class IIa indication in European Association of Cardio-Thoracic Surgery (EACTS) and a Class I indication in International Society of Minimally Invasive Cardiac Surgery (ISMICS) guidelines.

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“…Risk factors selection was based on previous studies (10,11,(15)(16)(17)(18) and clinical experience. Factors chosen were those easily measured and recorded.…”

Section: Rationale For Risk Factor Selectionmentioning

confidence: 99%

A Novel Risk Scoring Tool to Predict Saphenous Vein Graft Occlusion in patients with type 2 diabetes mellitus after Cardiac Artery Bypass Graft Surgery

Cheng

Liu

et al. 2020

Preprint

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Background: Coronary artery bypass grafting (CABG) success is reduced by graft occlusion. Patients with type 2 diabetes mellitus(T2DM) are more likely to develop graft occlusion. Understanding factors associated with graft occlusion may improve T2DM patient outcomes. The aim of this study was to develop a predictive risk score for saphenous vein graft (SVG) occlusion in T2DM patients after CABG.Methods: This retrospective cohort study enrolled 3716 CABG patients with T2DM from January 2012 to March 2013. The development cohort included 2477 patients and the validation cohort included 1239 patients. The baseline clinical data at index CABG was analyzed for their independent impact on graft occlusion in our study using Cox proportional hazards regression. The predictive risk scoring tool was weighted by beta coefficients from the final model. Concordance (c)-statistics and comparison of the predicted and observed probabilities of predicted risk were used for discrimination and calibration.Results: A total of 959 (25.8%) out of 3716 patients developed at least one SVG occlusion. Significant risk factors for occlusion were male sex, estimated glomerular filtration rate<90, smoking (currently), hyperuricemia, dyslipidemia, prior percutaneous coronary intervention (PCI), a rising number of lesion vessels, and SVG. On-pump surgery, and the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) were protective factors. The risk scoring tool with 11 variables was developed from the derivation cohort, which delineated each patient into risk quartiles. The c-statistic for this model was 0.71 in the validation cohort.Conclusions: An easy-to-use risk scoring tool that used common clinical variables was developed and validated. The scoring tool accurately estimated the risk of late SVG occlusion in T2DM patients after CABG.

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

Cited by 38 publications

References 64 publications

Development and Validation of a Score for Screening Suicide of Patients With Neuroendocrine Neoplasms

Development and Validation of a Score for Screening Suicide of Patients With Neuroendocrine Neoplasms

Endoscopic vein harvesting

A Novel Risk Scoring Tool to Predict Saphenous Vein Graft Occlusion in patients with type 2 diabetes mellitus after Cardiac Artery Bypass Graft Surgery

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