Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, Tehran, Iran.
BMC Cardiovasc Disord. 2024 Feb 16;24(1):110. doi: 10.1186/s12872-024-03781-7.
Frailty is proposed as a predictor of outcomes in patients undergoing major surgeries, although data on the association of frailty and coronary artery bypass grafting (CABG) are lacking. We assessed the association between frailty and cognitive and clinical complications following CABG.
This prospective study included patients aged over 60 years undergoing elective CABG at Tehran Heart Center from 2020 to 2022. Baseline and three-month follow-up data on frailty using the Frail scale and clinical Frail scale, functional status using the Lawton Instrumental Activities of Daily Living Scale (IADL), cognitive function by Montreal Cognitive Assessment (MoCA), and depression by the Geriatric Depression Scale (GDS) were obtained. The incidence of adverse outcomes was investigated at the three-month follow-up. Outcomes between frail and non-frail groups were compared utilizing T-tests and Mann-Whitney U tests, as appropriate.
We included 170 patients with a median age of 66 ± 4 years (75.3% male). Of these, 58 cases were classified as frail, and 112 individuals were non-frail, preoperatively. Frail patients demonstrated significantly worse baseline MOCA scores (21.08 vs. 22.41, P = 0.045), GDS (2.00 vs. 1.00, P = 0.009), and Lawton IADL (8.00 vs. 6.00, P < 0.001) compared to non-frail. According to 3-month follow-up data, postoperative MOCA and GDS scores were comparable between the two groups, while Lawton IADL (8.00 vs. 6.00, P < 0.001) was significantly lower in frail cases. A significantly higher rate of readmission (1.8% vs. 12.1%), sepsis (7.1% vs. 19.0%), as well as a higher Euroscore (1.5 vs. 1.9), was observed in the frail group. A mildly significantly more extended ICU stay (6.00 vs. 5.00, p = 0.051) was shown in the frail patient.
Frailty showed a significant association with a worse preoperative independence level, cognitive function, and depression status, as well as increased postoperative complications.
衰弱被认为是预测接受大手术的患者结局的指标，但关于衰弱与冠状动脉旁路移植术（CABG）之间的关系的数据尚缺乏。本研究评估了衰弱与 CABG 术后认知和临床并发症之间的关联。
这是一项前瞻性研究，纳入了 2020 年至 2022 年在德黑兰心脏中心接受择期 CABG 的年龄超过 60 岁的患者。使用衰弱量表和临床衰弱量表在基线和 3 个月时评估衰弱情况，使用洛顿工具性日常生活活动量表（IADL）评估功能状态，使用蒙特利尔认知评估（MoCA）评估认知功能，使用老年抑郁量表（GDS）评估抑郁情况。在 3 个月的随访时，调查不良结局的发生率。使用 T 检验和 Mann-Whitney U 检验（视情况而定）比较衰弱组和非衰弱组之间的结局。
本研究共纳入 170 名中位年龄为 66±4 岁（75.3%为男性）的患者。其中，58 例术前被归类为衰弱，112 例为非衰弱。与非衰弱组相比，衰弱组患者的基线 MoCA 评分（21.08 分 vs. 22.41 分，P=0.045）、GDS（2.00 分 vs. 1.00 分，P=0.009）和洛顿 IADL（8.00 分 vs. 6.00 分，P<0.001）明显更差。根据 3 个月随访数据，两组患者术后 MoCA 和 GDS 评分无差异，而衰弱组的洛顿 IADL（8.00 分 vs. 6.00 分，P<0.001）明显更低。衰弱组的再入院率（1.8% vs. 12.1%）、脓毒症（7.1% vs. 19.0%）以及 Euroscore（1.5 分 vs. 1.9 分）更高。衰弱组患者的 ICU 停留时间（6.00 分 vs. 5.00 分，p=0.051）略长。
衰弱与术前独立性水平、认知功能和抑郁状态较差以及术后并发症增加显著相关。
