Abstract 4370239: Low Life’s Essential 8 Scores are Associated with Increased Risk of Revascularization After Coronary Artery Bypass and Percutaneous Coronary Intervention

Abstract

Background: The American Heart Association’s Life Essential 8 (LE8) framework quantifies cardiovascular health (CVH) across key modifiable factors. Patients with prior history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) have an elevated risk of repeat adverse cardiovascular events. While LE8 scores have been used to assess overall CVH, the impact of revascularization on LE8 scores and their relationship to revascularization risk (RevR) in this population remains unclear. Methods: Post-procedure PCI (n=428) and CABG (n = 137) patients from the NIH’s updated All of Us Research program Version 8 (2017-2023) were included. Overall LE8 and component scores, excluding diet, were calculated per AHA methods (range 0-100, higher = better CVH). Individual scores were assigned to time-after-revascularization intervals and analyzed longitudinally by revascularization method. Patients were then stratified into one of four LE8 tiers: ≤ 50, >50-<60, 60-<70, and ≥ 70. Logistic regression models, adjusted for age, sex, race, and socioeconomic status were used to estimate odds ratios (OR) of repeat revascularization, using LE8 ≥70 as the reference group. Results: The mean overall LE8 score for the combined population was low at 56.6(PCI: 56.7, 95% CI 56.0-57.9; CABG: 55.2, 95% CI 53.8-56.7). Average nicotine (PCI: 47.1; CABG: 39.2), sleep (PCI: 62.8; CABG: 60.1), BMI (PCI: 51.6; CABG: 54.8), blood pressure (PCI: 61.1; CABG: 58.8), and blood glucose (PCI: 57.5; CABG: 55.5) scores were significantly lower than those of the general population. Post-procedure blood lipid and blood pressure scores remained significantly low over a 10 year period (Figure 1A, 1C). HbA1c score remained largely unchanged over the same period (Figure 1B). Patients with LE8 scores <50 had significantly higher odds of repeat revascularization compared to those with scores ≥70 (OR: 3.19, 95% CI 1.07-9.72, p=0.037). No significant differences in RevR were observed for patients with LE8 scores between >50 -<60, 60 -<70, and ≥70 (Figure 2). Conclusions: Post-procedure PCI and CABG patients with lower LE8 scores had significantly higher odds of revascularization, particularly those with scores ≤50. Adverse scores in nicotine use, sleep, blood pressure, and blood glucose were most prominent compared to the general population. Integrating LE8 assessments into routine follow-up may help identify at-risk patients and guide targeted interventions to reduce repeat procedures.