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J Chest Surg

Published online April 20, 2022

Copyright © Journal of Chest Surgery.

Association Between the Frailty Index and Clinical Outcomes after Coronary Artery Bypass Grafting

Chan Hyeong Kim , M.D., Yoonjin Kang , M.D., Ji Seong Kim , M.D., Ph.D., Suk Ho Sohn , M.D., Ho Young Hwang , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Ho Young Hwang
Tel 82-2-2072-3020
Fax 82-2-764-3664
E-mail scalpel@snu.ac.kr
ORCID
https://orcid.org/0000-0002-8935-8118

Received: December 13, 2021; Revised: February 9, 2022; Accepted: March 13, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Risk assessment, Coronary artery bypass, Frailty

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J Chest Surg

Published online April 20, 2022

Copyright © Journal of Chest Surgery.

Association Between the Frailty Index and Clinical Outcomes after Coronary Artery Bypass Grafting

Chan Hyeong Kim , M.D., Yoonjin Kang , M.D., Ji Seong Kim , M.D., Ph.D., Suk Ho Sohn , M.D., Ho Young Hwang , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Ho Young Hwang
Tel 82-2-2072-3020
Fax 82-2-764-3664
E-mail scalpel@snu.ac.kr
ORCID
https://orcid.org/0000-0002-8935-8118

Received: December 13, 2021; Revised: February 9, 2022; Accepted: March 13, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Risk assessment, Coronary artery bypass, Frailty

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