CLEVELAND — A new study tested the potential of the Secondary Manifestations of Arterial Disease (SMART2) risk score for use in patients undergoing coronary artery bypass grafting (CABG).
Researchers from the Louis Stokes Cleveland VAMC and the Case School of Medicine at Case Western Reserve University, both in Cleveland, and colleagues conducted an external validation of the SMART2 score in a racially diverse high-risk national cohort (2010-2019) that underwent isolated coronary artery bypass grafting.
Included in the study were 27,443 male U.S. veterans undergoing CABG from 2010-2019. Results were reported in the Journal of the American Heart Association.1
The international research, which also included participation from VAMCs in Boston and Pittsburgh, calculated the preoperative SMART2 score and modeled the 5-year major adverse cardiovascular event—cardiovascular mortality+myocardial infarction+stroke—incidence.
Results indicated that, nationwide, the 5-year major adverse cardiovascular event rate was 25%; 27% patients were in high predicted risk (>30% 5-year major adverse cardiovascular events). “SMART2 score discrimination (c-statistic: 64) was comparable to the original study (c-statistic: 67) and was best in patients with chronic kidney disease (c-statistic: 66),” the authors wrote. “However, it underpredicted major adverse cardiovascular event rates in the whole cohort (observed/expected ratio, 1.45) as well as in all studied subgroups. The SMART2 score performed better in white than Black patients.”
The study concluded that, on decision curve analysis, the SMART2 score provides a net benefit over a wide range of risk thresholds.
“The SMART2 model performs well in a racially diverse coronary artery bypass grafting cohort, with better predictive capabilities at the upper range of baseline risk, and can therefore be used to guide secondary preventive pharmacotherapy,” the study advised.
- Deo SV, Althouse A, Al-Kindi S, McAllister DA, Orkaby A, Elgudin YE, Fremes S, Chu D, Visseren FLJ, Pell JP, Sattar N. Validating the SMART2 Score in a Racially Diverse High-Risk Nationwide Cohort of Patients Receiving Coronary Artery Bypass Grafting. J Am Heart Assoc. 2023 Nov 7;12(21):e030757. doi: 10.1161/JAHA.123.030757. Epub 2023 Oct 27. PMID: 37889195.
