University of Oulu

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 Saccocci, Karl Bounader, Eeva-Maija Kinnunen, Tuomas Tauriainen, Juhani Airaksinen, Fulvia Seccareccia, Giovanni Mariscalco, Vito G Ruggieri, Andrea Perrotti, Fausto Biancari, Clinical frailty scale and outcome after coronary artery bypass grafting, European Journal of Cardio-Thoracic Surgery, Volume 54, Issue 6, December 2018, Pages 1102–1109,

Clinical frailty scale and outcome after coronary artery bypass grafting

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Author: Reichart, Daniel1; Rosato, Stefano2; Nammas, Wail3;
Organizations: 1Hamburg University Heart Center, Hamburg, Germany
2National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy
3Heart Center, Turku University Hospital, University of Turku, Turku, Finland
4Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
5Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
6Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
7Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
8Department of Cardiothoracic Sciences, University of Campania, Naples, Italy
9Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Città di Lecce Hospital GVM Care&Research, Lecce, Italy
10Centro Clinico-Diagnostico “G.B. Morgagni”, Centro Cuore, Pedara, Italy
11Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
12Division of Cardiac Surgery, University of Genoa, Genoa, Italy
13Division of Cardiac Surgery, University of Parma, Parma, Italy
14Department of Cardiac Surgery, Centro Cardiologico – Fondazione Monzino IRCCS, University of Milan, Italy
15Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
16Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
17Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
18Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
19Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
20Department of Surgery, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Oxford University Press, 2018
Publish Date: 2019-10-22


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.

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Series: European journal of cardio-thoracic surgery
ISSN: 1010-7940
ISSN-E: 1873-734X
ISSN-L: 1010-7940
Volume: 54
Issue: 6
Pages: 1102 - 1109
DOI: 10.1093/ejcts/ezy222
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Cardio-Thoracic Surgery following peer review. The version of record [insert complete citation information here] is available online at: