Risk stratification of coronary revascularization patients by using clinical and angiographic data

M. Goto, Shun Kosaka, V. V. Lee, M. A. Elayda, N. Aoki, J. M. Wilson

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5 Citations (Scopus)

Abstract

Aim. Patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are still at a substantial risk of death after their procedures. A core group of preoperative and preprocedural risk factors and conditions contributes the majority of inherent mid- and long-term mortality risk in these patients. Therefore, we sought to develop a classification tree model as a practical and userfriendly method of predicting mid-term survival after coronary revascularization procedures. Methods. We retrospectively analyzed data from a single, large-volume institution. Specifically, we examined all-cause three-year mortality in 3387 consecutive patients with multivessel or single proximal left anterior descending coronary artery disease who underwent either PCI with stenting or CABG. Results. Recursive partitioning indicated that the best single predictor of death within three years was a history of heart failure (HF), followed by a proximal left circumflex artery (pLCX) lesion and age greater than 65 years for patients with and without a history of HF, respectively. With these variables, patients were readily stratified into low-, intermediate-, and high-risk groups whose risks of death over three years ranged from 2.3% to 36.2%. Among patients with a history of HF, pLCX stenosis was an independent predictor of mid-term mortality after adjustment for other known risk factors (hazard ratio, 1.46; 95% CI, 1.04-2.03). Conclusion. The constructed risk stratification scheme stratified patients into groups at low, intermediate, and high risk of death within three years. Stenosis of the pLCX seems to be an important prognostic factor for patients with a history of HF.

Original languageEnglish
Pages (from-to)863-871
Number of pages9
JournalJournal of Cardiovascular Surgery
Volume52
Issue number6
Publication statusPublished - 2011 Dec
Externally publishedYes

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Keywords

  • Cardiovascular diseases
  • Myocardial revascularization
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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