Hamburg University Heart Center, Hamburg, Germany.
National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy.
Eur J Cardiothorac Surg. 2018 Dec 1;54(6):1102-1109. doi: 10.1093/ejcts/ezy222.
The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it may improve the predictive ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE II).
The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicentre E-CABG registry, and patients were stratified into 3 classes: scores 1-2, scores 3-4 and scores 5-7.
Of the 6156 patients enrolled, 39.2% had CFS scores 1-2, 57.6% scores 3-4, and 3.2% scores 5-7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality [CFS scores 3-4, odds ratio (OR) 3.95, 95% confidence interval (CI) 2.19-7.14; CFS scores 5-7, OR 5.90, 95% CI 2.67-13.05] and resulted in an Integrated Improvement Index of 1.3 (P < 0.001) and a Net Reclassification Index of 55.6 (P < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (P < 0.001) and Net Reclassification Index of 59.6 (P < 0.001) for prediction of hospital/30-day mortality with a significantly larger area under the receiver operating characteristics curve (0.809 vs 0.781, P = 0.028). The CFS was an independent predictor of mid-term mortality [CFS scores 3-4, hazard ratio (HR) 2.05, 95% CI 1.43-2.85; CFS scores 5-7, HR 3.05, 95% CI 1.83-5.06].
The CFS predicted early- and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery.
CLINICALTRIALS.GOV NUMBER: NCT02319083.
本研究旨在评估衰弱对冠状动脉旁路移植术（CABG）后结局的影响，以及它是否可以提高欧洲心脏手术风险评估系统（EuroSCORE II）的预测能力。
从多中心 E-CABG 登记处评估接受单纯 CABG 的患者术前的临床虚弱量表（CFS），并将患者分为 3 个等级：评分 1-2、评分 3-4 和评分 5-7。
在纳入的 6156 例患者中，39.2%的患者 CFS 评分为 1-2，57.6%的患者 CFS 评分为 3-4，3.2%的患者 CFS 评分为 5-7。多变量校正的逻辑回归显示，CFS 是住院/30 天死亡率的独立预测因子[CFS 评分 3-4，比值比（OR）3.95，95%置信区间（CI）2.19-7.14；CFS 评分 5-7，OR 5.90，95%CI 2.67-13.05]，并导致综合改善指数增加 1.3（P<0.001），对住院/30 天死亡率的净重新分类指数增加 55.6（P<0.001）。将 CFS 分级添加到 EuroSCORE II 中，对住院/30 天死亡率的预测，综合改善指数增加 0.9（P<0.001），净重新分类指数增加 59.6（P<0.001），并显著增加了接收者操作特征曲线下的面积（0.809 比 0.781，P=0.028）。CFS 是中期死亡率的独立预测因子[CFS 评分 3-4，风险比（HR）2.05，95%CI 1.43-2.85；CFS 评分 5-7，HR 3.05，95%CI 1.83-5.06]。
CFS 预测了接受单纯 CABG 的患者的早期和中期死亡率。需要进一步的研究来评估衰弱是否可以改善成人心脏手术患者手术风险的估计。
NCT02319083。
