title: A new anatomic score for prognosis after cardiac catheterization in patients with previous bypass surgery.
abstract: OBJECTIVE
  The purpose of this study was to determine the value of a new anatomic score for prognosis after diagnostic catheterization in patients with previous coronary artery bypass grafting (CABG).
  
  
  BACKGROUND
  Previous CABG patients comprise a growing proportion of patients with coronary artery disease (CAD). Whereas prognostic scores are available to adjust for native CAD, there are no comparable scores for patients with previous CABG.
  
  
  METHODS
  We studied 3,178 previous CABG patients (2,729 in a training set) who underwent cardiac catheterization. With a Cox model to develop relative weights in the training set, we created a graft index that adjusted native anatomy for territories with grafts free of significant (> or =75%) stenoses. Scaling the regression coefficients by the maximum coefficient created an index ranging from 0 to 100, where 100 was three-vessel CAD with no patent grafts.
  
  
  RESULTS
  The graft index was significantly associated with all-cause death (chi-square = 121.9, p < 0.001). In combined models, the index was more strongly associated with all-cause death than either number of diseased vessels (chi-square = 68.0 and 1.7, respectively) or the Duke CAD index (chi-square = 54.3 and 9.5, respectively). In models for death using an independent validation set, the index was also associated more strongly than either native disease descriptors. In a model including other clinical variables, the graft index remained significantly associated with all-cause death (chi-square = 40.1, p < 0.001).
  
  
  CONCLUSIONS
  For previous CABG patients, the Duke graft index was significantly more associated with prognosis than native anatomy alone and quantifies the effect of patent grafts on survival. This tool has the potential to help determine prognosis and inform the referral of post-CABG patients to repeat revascularization procedures.
authors.affiliation: Duke Clinical Research Institute, USA. Liao0002@mc.duke.edu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Liao
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sketch
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis