Construction of a Risk Stratification and Early Warning Model for Bridge Vessel Lesions After CABG and Evaluation of Its Clinical Utility

HAN Bing; ZHENG Daokuo; FENG Shijun; WU Xuezhi; MEI Yongcheng; WU Liwen

doi:10.3969/j.issn.1004-437X.2026.05.009

Abstract：Objective To construct a risk stratification warning model for bridge vessel lesions after coronary artery bypass grafting(CABG)and evaluate its clinical utility.Methods A retrospective study was conducted on 276 patients who underwent CABG and subsequently experienced chest tightness/chest pain and underwent coronary angiography at Zhumadian Central Hospital and Henan Chest Hospital from January 2018 to January 2024,serving as the modeling set.According to the occurrence of bridge vascular lesions at 1 year after operation,they were divided into occurrence group and non-occurrence group.Additionally,90 patients from February to December 2024 were selected for external validation of the established model.The clinical data of patients in the occurrence group and non-occurrence group in the modeling set were compared.Univariate and multivariate analysis were used to screen the risk factors of bridge vessel disease after CABG,and internal and external validation were performed.Results The proportions of female(73.96％),hypertension(52.08％),smoking history(19.79％),venous graft type(62.50％),and diffuse coronary artery disease(41.67％)in the occurrence group were higher than those in the non-occurrence group(52.22％,29.44％,5.56％,38.89％,20.56％,respectively),the graft flow rate[(20.28±5.32)mL·min-1]was lower than that in the non-occurrence group[(24.62±6.01)mL·min-1],and the proportion of postoperative medication adherence(43.75％)was lower than that in the non-occurrence group(66.67％),with statistically significant differences(P＜0.05).Hypertension,vein graft,diffuse coronary artery disease,graft flow,and postoperative medication compliance were the influencing factors of the risk of graft disease after CABG.The consistency index of the early warning model was 0.821.The area under the curve of the model in internal and external validation was 0.887(95％CI:0.848-0.927)and 0.848(95％CI:0.763-0.933),respectively.The decision curve analysis(DCA)and calibration curve indicated that the model had excellent calibration and clinical utility.Conclusion The influencing factors of the risk of postoperative bridging vascular disease in CABG patients undergoing coronary angiography due to clinical symptoms(chest tightness/chest pain)are hypertension,venous bridge,diffuse coronary artery disease,bridging vascular flow,and postoperative compliance with medical drugs.The early warning model constructed according to it shows good discrimination,calibration and clinical utility in this specific population,which is helpful for early clinical identification of high-risk populations and provides a reference for individualized treatment intervention decisions.