Novel algorithms to predict 10-year mortality and MACCE after coronary artery bypass grafting

Aims: The PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary artery bypass surgerY) project was designed to identify preoperative risk factors for 10-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) after isolated coronary artery bypass grafting (CABG). Methods: PRIORITY is an observational cohort study merging two prospective multicenter studies conducted in 2002-2004 and 2007-2008 on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. The primary endpoint was long-term all-cause mortality and the secondary endpoint was a composite of MACCE. Results: The study cohort included 10 989 patients with complete 10-year follow-up. Mortality up to 10 years was associated with almost all variables defined by EuroSCORE and the risk factors with higher impact were left ventricular ejection fraction (LVEF) <30% [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.95-2.69], diabetes (HR 3.17, 95% CI 2.31-4.34), and cirrhosis (HR 3.90, 95% CI 2.09-7.28). Also, 10-year MACCE was affected by preoperative comorbidities defined by EuroSCORE, with different weights compared with 30-day prediction scores. The risk factors with the worst effect on long-term MACCE were LVEF <30% (HR 1.61, 95% CI 1.39-1.86), dialysis (HR 2.52, 95% CI 1.87-3.40), and cirrhosis (HR 1.93, 95% CI 1.09-3.41). Both scores demonstrated good performance in terms of discrimination and calibration. Conclusion: The PRIORITY study confirms the importance of long-term follow-up for patients who undergo CABG and has led to the design of online risk calculators for predicting all-cause mortality and MACCE up to 10 years to support the clinical management of patients.