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Prognostic assessment of coronary artery bypass patients based on coronary CTA: vessel weight and native artery lesions aid in predicting cardiovascular events

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Chinese Journal of Academic Radiology Aims and scope Submit manuscript

Abstract

Purpose

The Fitzgibbon classification and Coronary Artery Disease—Reporting and Data System (CAD-RADS) were the main assessment methods for graft patency in post-coronary artery bypass graft (CABG) patients. Yet they only included the stenosis degree and have limited predictive power for long-term outcomes. We thus developed a novel scoring system (graft score) for graft evaluation in post-CABG patients by integrating stenosis degree, vessel weight coefficient, and native artery lesions based on coronary computed tomography angiography (CCTA) for guiding and optimizing post-CABG treatment.

Methods

This retrospective study enrolled consecutive post-CABG patients indicated for 1-year follow-up CCTA examination. The primary outcome was major adverse cardiovascular event (MACE). Multivariable Cox regression analysis, Harrell’s C-statistics, and continuous net reclassification were used for statistical analyses.

Results

A total of 402 patients (median age: 64 years, interquartile range: 58–69; 81.19% males) were included. Inclusion of the graft score or CAD-RADS while constructing clinical prediction models brought a significant net reclassification improvement (NRI) in MACE (graft score: NRI = 0.558, 95% CI 0.533–0.584, p < 0.001; CAD-RADS: NRI = 0.065, 95% CI 0.038–0.093, p = 0.017) compared with the inclusion of Fitzgibbon classification. Inclusion of the graft score significantly improved reclassification of the model with the CAD-RADS (NRI = 0.449, 95% CI 0.428–0.471, p < 0.001). In contrast, the modified Fitzgibbon classification did not provide such predictive superiority (NRI = 0.014, 95% CI  − 0.011 to 0.039, p = 0.567).

Conclusions

The novel graft score based on CCTA outperformed the other three assessment methods in predicting the occurrence of MACEs suggesting that stenosis degree, vessel weight, and native coronary artery lesions should be all integrated in graft evaluation in post-CABG patients.

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Availability of data and materials

Data generated or analyzed during the study are available from the corresponding author by request.

Abbreviations

CABG:

Coronary artery bypass grafting

CCTA:

Coronary computed tomography angiography

MACE:

Major adverse cardiovascular event

NRI:

Net reclassification improvement

CAD-RADS:

Coronary artery disease-reporting and data system of CCTA

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Funding

Natural Science Foundation of China under Grant 8217070113; Innovative Research Team of High-level Local Universities in Shanghai.

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Author notes

  1. Liwen Han and Mi Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Liwen Han, Fuhua Yan & Wenjie Yang

  2. Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Mi Zhou, Yunpeng Zhu & Qiang Zhao

  3. Siemens Healthineers Computed Tomography (CT) Collaboration, Shanghai, China

    Zhihan Xu

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  1. Liwen Han
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Liwen Han, Mi Zhou, and Zhihan Xu. The first draft of the manuscript was written by Liwen Han and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wenjie Yang.

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This retrospective study was approved by the Institutional Review Board of our institution and written informed consent was waived due to the retrospective nature of the study.

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Han, L., Zhou, M., Zhu, Y. et al. Prognostic assessment of coronary artery bypass patients based on coronary CTA: vessel weight and native artery lesions aid in predicting cardiovascular events. Chin J Acad Radiol 7, 79–91 (2024). https://doi.org/10.1007/s42058-024-00141-4

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