{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:37:12Z","timestamp":1787960232122,"version":"build-2784847793"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We tested the potential of the Secondary Manifestations of Arterial Disease (SMART2) risk score for use in patients undergoing coronary artery bypass grafting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We conducted an external validation of the SMART2 score in a racially diverse high\u2010risk national cohort (2010\u20132019) that underwent isolated coronary artery bypass grafting. We calculated the preoperative SMART2 score and modeled the 5\u2010year major adverse cardiovascular event (cardiovascular mortality+myocardial infarction+stroke) incidence. We evaluated SMART2 score discrimination at 5\u2009years using c\u2010statistic and calibration with observed\/expected ratio and calibration plots. We analyzed the potential clinical benefit using decision curves. We repeated these analyses in clinical subgroups, diabetes, chronic kidney disease, and polyvascular disease, and separately in White and Black patients. In 27\u2009443 (mean age, 65\u2009years; 10% Black individuals) US veterans undergoing coronary artery bypass grafting (2010\u20132019) nationwide, the 5\u2010year major adverse cardiovascular event rate was 25%; 27% patients were in high predicted risk (&gt;30% 5\u2010year major adverse cardiovascular events). SMART2 score discrimination (c\u2010statistic: 64) was comparable to the original study (c\u2010statistic: 67) and was best in patients with chronic kidney disease (c\u2010statistic: 66). 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. On decision curve analysis, the SMART2 score provides a net benefit over a wide range of risk thresholds.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.030757","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T14:07:59Z","timestamp":1698415679000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Validating the SMART2 Score in a Racially Diverse High\u2010Risk Nationwide Cohort of Patients Receiving Coronary Artery Bypass Grafting"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4729-1461","authenticated-orcid":false,"given":"Salil V.","family":"Deo","sequence":"first","affiliation":[{"name":"Louis Stokes Cleveland Veteran Affairs Medical Center Cleveland OH"},{"name":"Case School of Medicine, Case Western Reserve University Cleveland OH"},{"name":"School of Health and Wellbeing University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8654-5014","authenticated-orcid":false,"given":"Andrew","family":"Althouse","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Pittsburgh Pittsburgh PA"},{"name":"Medtronic Corporation Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-7695","authenticated-orcid":false,"given":"Sadeer","family":"Al\u2010Kindi","sequence":"additional","affiliation":[{"name":"Case School of Medicine, Case Western Reserve University Cleveland OH"},{"name":"Department of Cardiology University Hospitals Cleveland Medical Center Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"McAllister","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4297-6306","authenticated-orcid":false,"given":"Ariela","family":"Orkaby","sequence":"additional","affiliation":[{"name":"New England Geriatric Research, Education, and Clinical Center, VA Boston, Healthcare System Boston MA"},{"name":"Division of Aging, Brigham and Women\u2019s Hospital Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5249-1820","authenticated-orcid":false,"given":"Yakov E.","family":"Elgudin","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veteran Affairs Medical Center Cleveland OH"},{"name":"Case School of Medicine, Case Western Reserve University Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1723-3049","authenticated-orcid":false,"given":"Stephen","family":"Fremes","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2183-6072","authenticated-orcid":false,"given":"Danny","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Pittsburgh VA Medical Center Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-5223","authenticated-orcid":false,"given":"Frank L. J.","family":"Visseren","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill P.","family":"Pell","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1604-2593","authenticated-orcid":false,"given":"Naveed","family":"Sattar","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2008.tb01587.x"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.10.001"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjqcco\/qcaa032"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.04.107"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14738"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0570"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.005404"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac056"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab093"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.11.045"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10143032"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0054"},{"key":"e_1_3_2_15_2","volume-title":"VA Leads the Way in Reporting Surgical Outcomes","author":"Health Sciences Research Department","year":"2018","unstructured":"Health Sciences Research Department . 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