THE PRIORITY STUDY - PREDICTING LONG TERM OUTCOMES AFTER ISOLATED CORONARY ARTERY BYPASS SURGERY

Aims: The PRIORITY (PRedictIng long term Outcomes afteR Isolated coronary artery bypass surgerY) project aims to improve predictions for long-term outcomes after isolated coronary artery bypass grafting (CABG) by identifying pre-operative risk factors for 10-year mortality and MACCE. Materials and Methods: The project 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 at 10 years after the intervention. The primary outcome was long term mortality and the secondary outcome a composite of Major Adverse Cardiac and Cerebrovascular Event (MACCE). Results: The study cohort included 10,989 patients with complete 10-year follow-up. We analyzed the relationship between 10-year all-cause mortality and major risk factors, which were LVEF <30% (HR 2.290, 95% CI 1.947-2.694), treated diabetes (HR 3.166, 95% CI 2.307-4.343), and cirrhosis (HR 3.898, 95% CI 2.087-7.281). Cox semi-parametric analysis showed that preoperative comorbidities and baseline characteristics relate to 10-year MACCE, with LVEF <30% (HR 1.606, 95% CI 1.390-1.855), dialysis (HR 2.522, 95% CI 1.873-3.396), and cirrhosis (HR 1.930, 95% CI 1.092-3.409) as high-risk factors. External validation of the reduced model demonstrated good calibration and discrimination (Integrated Time-dependent AUC 0.753). Conclusion: This predictive model provides a valuable tool for estimating 10-year mortality and MACCE in CABG patients. The strength of this model lies in its validation with an external cohort. Future prospective studies could further establish its utility, integrating it into clinical decision-making to improve patient care and optimize outcomes.