Frailty syndrome as an independent predictor of unfavorable outcome in patients undergoing coronary artery bypass grafting
Authors: Krivoshapova K E , Barbarash O L G A , Masenko V L , Kokov A N , Terentyeva N A 
Published: October 2021

Abstract

Purpose
To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG).

Methods
387 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the “Age is no disqualification” scores suggesting the presence or absence of frailty and the presence of prefrailty. Demographic and clinical data were collected for each patient, including surgery data, pre- and postoperative treatment, intra- and postoperative complications and outcomes of CABG. Statistical analysis was performed using the commercially available software package IBM SPSS Statistics 26.0.0.

Results
74 (19%) patients had frailty, while 225 (58%) patients were diagnosed with prefrailty and 88 (23%) patients did not have any signs of frailty. All three groups had significant age differences, patients without frailty – 56 [63–67] years old, prefrailty group – 59 [65–69] years old, patients with frailty – 62 [66–72] years old, p=0,003. Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty – 14,8%, prefrailty group – 25,8% and frailty group – 36,5%, p=0,006), atrial fibrillation or flutter (16,7%, 14,3% and 35,6%, respectively, p=0,05) and cerebral atherosclerosis (45,5%, 62,2% and 60,8%, respectively, p=0,02). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of infections (3,4%, 2,2% and 4%, respectively, p=0,655) and haemorrhagic complications (1,2%, 1% and 0,5%, respectively, p=0,680). Patients with frailty or prefrailty in the intra- and early postoperative period after CABG had significantly higher incidence of low output syndrome (1,2%, 7,6% and 13,5%, respectively, p=0,01, OR 8,5, 95% CI, 1,1–63,5) and postoperative atrial fibrillation or flutter (5,7%, 16% and 12,2%, respectively, p=0,04, OR 2,9, 95% CI, 1,1–7,5). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0%, 0,5% and 1,5%, respectively, p=0,476) as well as the incidence of stroke (2,3%, 1,8% and 4,1%, respectively, p=0,523). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (1%, 0% and 5,4%, respectively, p=0,04, OR 2,6, 95% CI, 1,1–5,9).

Conclusion
Almost 19% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”, Kemerovo, Russian Federation