Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Association Between the Frailty Index and Clinical Outcomes after Coronary Artery Bypass Grafting

  • Kim, Chan Hyeong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Yoonjin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Ji Seong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sohn, Suk Ho (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2021.12.13
  • Accepted : 2022.03.13
  • Published : 2022.06.05
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Abstract

Background: This study investigated the predictive value of the frailty index calculated using laboratory data and vital signs (FI-L) in patients who underwent coronary artery bypass grafting (CABG). Methods: This study included 508 patients (age 67.3±9.7 years, male 78.0%) who underwent CABG between 2018 and 2021. The FI-L, which estimates patients' frailty based on laboratory data and vital signs, was calculated as the ratio of variables outside the normal range for 32 preoperative parameters. The primary endpoints were operative and medium-term all-cause mortality. The secondary endpoints were early postoperative complications and major adverse cardiac and cerebrovascular events (MACCEs). Results: The mean FI-L was 20.9%±10.9%. The early mortality rate was 1.6% (n=8). Postoperative complications were atrial fibrillation (n=148, 29.1%), respiratory complications (n=38, 7.5%), and acute kidney injury (n=15, 3.0%). The 1- and 3-year survival rates were 96.0% and 88.7%, and the 1- and 3-year cumulative incidence rates of MACCEs were 4.87% and 8.98%. In multivariable analyses, the FI-L showed statistically significant associations with medium-term all-cause mortality (hazard ratio [HR], 1.042; 95% confidence interval [CI], 1.010-1.076), MACCEs (subdistribution HR, 1.054; 95% CI, 1.030-1.078), atrial fibrillation (odds ratio [OR], 1.02; 95% CI, 1.002-1.039), acute kidney injury (OR, 1.06; 95% CI, 1.014-1.108), and re-operation for bleeding (OR, 1.09; 95% CI, 1.032-1.152). The minimal p-value approach showed that 32% was the best cutoff for the FI-L as a predictor of all-cause mortality post-CABG. Conclusion: The FI-L was a significant prognostic factor related to all-cause mortality and postoperative complications in patients who underwent CABG.

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References

  1. Alexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med 2016;374:1954-64. https://doi.org/10.1056/NEJMra1406944
  2. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011;58:e123-210. https://doi.org/10.1016/j.jacc.2011.08.009
  3. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013;381:629-38. https://doi.org/10.1016/S0140-6736(13)60141-5
  4. Mohr F, Redwood S, Venn G, et al. TCT-43 final five-year follow-up of the SYNTAX trial: optimal revascularization strategy in patients with three-vessel disease. J Am Coll Cardiol 2012;60(17_Suppl):B13.
  5. Kappetein AP, Feldman TE, Mack MJ, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011;32:2125-34. https://doi.org/10.1093/eurheartj/ehr213
  6. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-45. https://doi.org/10.1093/ejcts/ezs043
  7. Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. Ann Thorac Surg 2009;88(1 Suppl):S2-22. https://doi.org/10.1016/j.athoracsur.2009.05.053
  8. Sullivan PG, Wallach JD, Ioannidis JP. Meta-analysis comparing established risk prediction models (EuroSCORE II, STS Score, and ACEF Score) for perioperative mortality during cardiac surgery. Am J Cardiol 2016;118:1574-82. https://doi.org/10.1016/j.amjcard.2016.08.024
  9. Sepehri A, Beggs T, Hassan A, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg 2014;148:3110-7. https://doi.org/10.1016/j.jtcvs.2014.07.087
  10. Sohn B, Choi JW, Hwang HY, Jang MJ, Kim KH, Kim KB. Frailty index is associated with adverse outcomes after aortic valve replacement in elderly patients. J Korean Med Sci 2019;34:e205. https://doi.org/10.3346/jkms.2019.34.e205
  11. Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011;27:17-26. https://doi.org/10.1016/j.cger.2010.08.008
  12. Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 1994;86:829-35. https://doi.org/10.1093/jnci/86.11.829
  13. Wu C, Camacho FT, Wechsler AS, et al. Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation 2012;125:2423-30. https://doi.org/10.1161/CIRCULATIONAHA.111.055939
  14. Zaidi AM, Fitzpatrick AP, Keenan DJ, Odom NJ, Grotte GJ. Good outcomes from cardiac surgery in the over 70s. Heart 1999;82:134-7. https://doi.org/10.1136/hrt.82.2.134
  15. Fruitman DS, MacDougall CE, Ross DB. Cardiac surgery in octogenarians: can elderly patients benefit?: quality of life after cardiac surgery. Ann Thorac Surg 1999;68:2129-35. https://doi.org/10.1016/S0003-4975(99)00818-8
  16. Dalrymple-Hay MJ, Alzetani A, Aboel-Nazar S, Haw M, Livesey S, Monro J. Cardiac surgery in the elderly. Eur J Cardiothorac Surg 1999;15:61-6. https://doi.org/10.1016/S1010-7940(98)00286-3
  17. Hirose H, Amano A, Yoshida S, Takahashi A, Nagano N, Kohmoto T. Coronary artery bypass grafting in the elderly. Chest 2000;117:1262-70. https://doi.org/10.1378/chest.117.5.1262
  18. Blodgett JM, Theou O, Howlett SE, Rockwood K. A frailty index from common clinical and laboratory tests predicts increased risk of death across the life course. Geroscience 2017;39:447-55. https://doi.org/10.1007/s11357-017-9993-7
  19. Howlett SE, Rockwood MR, Mitnitski A, Rockwood K. Standard laboratory tests to identify older adults at increased risk of death. BMC Med 2014;12:171. https://doi.org/10.1186/s12916-014-0171-9