Frailty as an Independent Predictor of Adverse Outcomes in Patients Undergoing Direct Myocardial Revascularization
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Kristina Krivoshapova1, Daria Tsygankova1, Evgeny Bazdyrev1
1Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo 650002, Russia.
Insights
Frail patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) face higher risks of complications and mortality. Frailty is an independent predictor of poor outcomes, necessitating its consideration in surgical risk assessment.
Area of Science:
- Cardiology
- Geriatrics
- Surgical Outcomes
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Frailty is increasingly recognized as a significant factor influencing patient outcomes, particularly in elderly populations undergoing major surgery.
- The impact of frailty on outcomes following coronary artery bypass grafting (CABG) requires further investigation.
Purpose of the Study:
- To determine the incidence of frailty in patients with stable CAD scheduled for CABG.
- To analyze the anamnestic characteristics of frail patients.
- To evaluate the role of frailty in perioperative complications and early survival after CABG.
Main Methods:
- A prospective study of 387 patients undergoing scheduled primary CABG.
- Frailty was assessed preoperatively using the PRISMA-7 questionnaire.
- Patients were divided into frail (n=87) and non-frail (n=300) groups for comparative analysis of outcomes.
Main Results:
- Frailty was identified in 22.5% of patients prior to CABG.
- Frail patients experienced significantly higher rates of postoperative rhythm disturbances (19.5% vs. 10.5%) and transient ischemic attacks/stroke (5.7% vs. 1.3%).
- Mortality was substantially higher in the frail group at early postoperative follow-up (4.5% vs. 0.3%) and at 1 year (11.5% vs. 0.6%), with frailty being an independent predictor of mortality.
Conclusions:
- Frailty is a prevalent condition in patients with CAD undergoing CABG and is associated with increased perioperative morbidity.
- Frailty serves as an independent predictor of unfavorable prognosis and mortality in the early survival period post-CABG.
- Preoperative assessment of frailty is crucial for accurate surgical risk stratification in patients with CAD undergoing CABG.
Abstract:
The aim of this study was to analyze the incidence and anamnestic characteristics of frail patients with stable coronary artery disease (CAD) and to evaluate the role of frailty in the development of complications and adverse outcomes in the perioperative period and early survival period after coronary artery bypass grafting (CABG).
Material And Methods:
The study included 387 patients admitted to the clinic for a scheduled primary CABG. A seven-item questionnaire, "PRISMA-7", was used to identify frail elderly patients before the procedure. We divided the study sample into two groups, taking into account the results of the survey: patients without frailty, n0 = 300 (77.5%), and patients with frailty, n1 = 87 (22.5%). The anamnestic and laboratory data, outcome of the surgical intervention, perioperative and early complications, and adverse outcomes were analyzed.
Results:
We detected frailty in 22.5% of the patients with CAD before the procedure. According to the anamnestic data and paraclinical and intraoperative findings, the groups of patients with and without frailty were comparable. The differences were revealed in the intraoperative and early postoperative periods of CABG. Thus, postoperative rhythm disturbances (19.5% vs. 10.5%, p = 0.025, V = 0.115, respectively) and transient ischemic attacks/stroke (5.7% vs. 1.3%, p = 0.031, V = 0.122, respectively) occurred significantly more often among the frail patients. There were no significant differences between the groups in the frequency of other intraoperative and early postoperative complications. In the group of frail patients, four fatal outcomes due to early postoperative ischemia were recorded, and among patients without frailty, one fatal outcome was recorded (4.5% vs. 0.3%, p = 0.010, V = 0.156, respectively). At the 1-year follow-up visit, the presence of frailty in history served as a predictor of mortality (11.5% vs. 0.6%, p ˂ 0.001, V = 0.290, respectively).
Conclusion:
The presence of frailty can be used as an independent predictor of an unfavorable prognosis in patients with CAD, both in the perioperative and early survival period after CABG. It should be taken into account during surgical risk assessment.
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