Clinical frailty scale and outcome after coronary artery bypass grafting

Daniel Reichart, Stefano Rosato, Wail Nammas, Francesco Onorati, Magnus Dalén, Liesa Castro, Riccardo Gherli, Giuseppe Gatti, Ilaria Franzese, Giuseppe Faggian, Marisa De Feo, Sorosh Khodabandeh, Giuseppe Santarpino, Antonino S. Rubino, Daniele Maselli, Saverio Nardella, Antonio Salsano, Francesco Nicolini, Marco Zanobini, Matteo SaccocciKarl Bounader, Eeva Maija Kinnunen, Tuomas Tauriainen, Juhani Airaksinen, Fulvia Seccareccia, Giovanni Mariscalco, Vito G. Ruggieri, Andrea Perrotti, Fausto Biancari

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: 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). METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)1102-1109
Number of pages8
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume54
Issue number6
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Coronary Artery Bypass
Mortality
Confidence Intervals
Odds Ratio
ROC Curve
Thoracic Surgery
Registries
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical frailty scale and outcome after coronary artery bypass grafting. / Reichart, Daniel; Rosato, Stefano; Nammas, Wail; Onorati, Francesco; Dalén, Magnus; Castro, Liesa; Gherli, Riccardo; Gatti, Giuseppe; Franzese, Ilaria; Faggian, Giuseppe; De Feo, Marisa; Khodabandeh, Sorosh; Santarpino, Giuseppe; Rubino, Antonino S.; Maselli, Daniele; Nardella, Saverio; Salsano, Antonio; Nicolini, Francesco; Zanobini, Marco; Saccocci, Matteo; Bounader, Karl; Kinnunen, Eeva Maija; Tauriainen, Tuomas; Airaksinen, Juhani; Seccareccia, Fulvia; Mariscalco, Giovanni; Ruggieri, Vito G.; Perrotti, Andrea; Biancari, Fausto.

In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Vol. 54, No. 6, 01.12.2018, p. 1102-1109.

Research output: Contribution to journalArticle

Reichart, D, Rosato, S, Nammas, W, Onorati, F, Dalén, M, Castro, L, Gherli, R, Gatti, G, Franzese, I, Faggian, G, De Feo, M, Khodabandeh, S, Santarpino, G, Rubino, AS, Maselli, D, Nardella, S, Salsano, A, Nicolini, F, Zanobini, M, Saccocci, M, Bounader, K, Kinnunen, EM, Tauriainen, T, Airaksinen, J, Seccareccia, F, Mariscalco, G, Ruggieri, VG, Perrotti, A & Biancari, F 2018, 'Clinical frailty scale and outcome after coronary artery bypass grafting', European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, vol. 54, no. 6, pp. 1102-1109. https://doi.org/10.1093/ejcts/ezy222
Reichart, Daniel ; Rosato, Stefano ; Nammas, Wail ; Onorati, Francesco ; Dalén, Magnus ; Castro, Liesa ; Gherli, Riccardo ; Gatti, Giuseppe ; Franzese, Ilaria ; Faggian, Giuseppe ; De Feo, Marisa ; Khodabandeh, Sorosh ; Santarpino, Giuseppe ; Rubino, Antonino S. ; Maselli, Daniele ; Nardella, Saverio ; Salsano, Antonio ; Nicolini, Francesco ; Zanobini, Marco ; Saccocci, Matteo ; Bounader, Karl ; Kinnunen, Eeva Maija ; Tauriainen, Tuomas ; Airaksinen, Juhani ; Seccareccia, Fulvia ; Mariscalco, Giovanni ; Ruggieri, Vito G. ; Perrotti, Andrea ; Biancari, Fausto. / Clinical frailty scale and outcome after coronary artery bypass grafting. In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2018 ; Vol. 54, No. 6. pp. 1102-1109.
@article{6953abb683344ab695e7b516be55502a,
title = "Clinical frailty scale and outcome after coronary artery bypass grafting",
abstract = "OBJECTIVES: 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). METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.",
author = "Daniel Reichart and Stefano Rosato and Wail Nammas and Francesco Onorati and Magnus Dal{\'e}n and Liesa Castro and Riccardo Gherli and Giuseppe Gatti and Ilaria Franzese and Giuseppe Faggian and {De Feo}, Marisa and Sorosh Khodabandeh and Giuseppe Santarpino and Rubino, {Antonino S.} and Daniele Maselli and Saverio Nardella and Antonio Salsano and Francesco Nicolini and Marco Zanobini and Matteo Saccocci and Karl Bounader and Kinnunen, {Eeva Maija} and Tuomas Tauriainen and Juhani Airaksinen and Fulvia Seccareccia and Giovanni Mariscalco and Ruggieri, {Vito G.} and Andrea Perrotti and Fausto Biancari",
year = "2018",
month = "12",
day = "1",
doi = "10.1093/ejcts/ezy222",
language = "English",
volume = "54",
pages = "1102--1109",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "6",

}

TY - JOUR

T1 - Clinical frailty scale and outcome after coronary artery bypass grafting

AU - Reichart, Daniel

AU - Rosato, Stefano

AU - Nammas, Wail

AU - Onorati, Francesco

AU - Dalén, Magnus

AU - Castro, Liesa

AU - Gherli, Riccardo

AU - Gatti, Giuseppe

AU - Franzese, Ilaria

AU - Faggian, Giuseppe

AU - De Feo, Marisa

AU - Khodabandeh, Sorosh

AU - Santarpino, Giuseppe

AU - Rubino, Antonino S.

AU - Maselli, Daniele

AU - Nardella, Saverio

AU - Salsano, Antonio

AU - Nicolini, Francesco

AU - Zanobini, Marco

AU - Saccocci, Matteo

AU - Bounader, Karl

AU - Kinnunen, Eeva Maija

AU - Tauriainen, Tuomas

AU - Airaksinen, Juhani

AU - Seccareccia, Fulvia

AU - Mariscalco, Giovanni

AU - Ruggieri, Vito G.

AU - Perrotti, Andrea

AU - Biancari, Fausto

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVES: 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). METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.

AB - OBJECTIVES: 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). METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.

UR - http://www.scopus.com/inward/record.url?scp=85054831185&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054831185&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezy222

DO - 10.1093/ejcts/ezy222

M3 - Article

C2 - 29897529

AN - SCOPUS:85054831185

VL - 54

SP - 1102

EP - 1109

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 6

ER -