Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


The impact of comprehensive geriatric assessment in elderly patients on early outcomes of coronary artery bypass grafting and percutaneous coronary intervention: a prospective study

Authors: Grishenok A.V., Buziashvili V.Yu., Matskeplishvili S.T., Golubev E.P., Sherstyannikova O.M., Gvaliya S.L., Buziashvili Yu.I.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2023-20-4-344-352

UDC: 616.12-053.9-089.819.5

Link: Clinical Physiology of Blood Circulaiton. 2023; 4 (20): 344-352

Quote as: Grishenok A.V., Buziashvili V.Yu., Matskeplishvili S.T., Golubev E.P., Sherstyannikova O.M., Gvaliya S.L., Buziashvili Yu.I. The impact of comprehensive geriatric assessment in elderly patients on early outcomes of coronary artery bypass grafting and percutaneous coronary intervention: a prospective study. Clinical Physiology of Circulation. 2023; 20 (4): 344–52 (in Russ.). DOI: 10.24022/1814-6910-2023-20-4-344-352

Received / Accepted:  04.10.2023 / 06.12.2023

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Abstract

Objective. To evaluate the relationship between comprehensive geriatric assessment and early outcomes of treatment in elderly patients with stable coronary artery disease, to identify parameters that affect the early outcomes of coronary artery bypass grafting and percutaneous coronary intervention.

Material and methods. The inclusion criteria were age over 75 years and need for myocardial revascularization. The exclusion criteria were emergency surgery cases. The study included 142 patients. In addition to the standard screening, all patients underwent comprehensive geriatric assessment. A comprehensive geriatric assessment was carried out according to the guidelines of the Russian society of geriatricians and gerontologists and included: frailty screening on the scale “Age is not a barrier”, cognitive assessment on the scale MOCA, depression screening on the scale GDS-15, grip strength, and short physical performance battery test including determination of walking speed, standing balance, sit-tostand performance.

Results. Percutaneous coronary intervention was performed in 56 (39.4%) patients, coronary artery bypass grafting was performed in 43 (30.3%) patients, and conservative treatment were chosen in 43 (30.3%) cases. Prevalence of geriatric syndromes was high, more than half of patients had more than 3 geriatric deficiency and a quarter of patients had a frailty. Patients, who underwent coronary artery bypass grafting, had higher hand grip strength (p<0.001) and faster walking speed (p<0.001). If the patient had frailty, the choice of coronary artery bypass grafting decreased by 3,6 times (odds ratio 0.274; 95% confidence interval 0.089–0.838). Statistically significant direct correlations were identified between the parameters of the functional status and the outcomes of coronary artery bypass grafting. Inverse correlations were identified between age and operative time, the volume of blood loss.

Conclusion. The comprehensive geriatric assessment is an important supplement to traditional methods of preoperative cardiac risk assessment and plays significant role in cardiovascular surgery risk stratification in elderly patients. According to the study, walking speed, standing balance, grip strength, sit- to-stand performance had a statistically significant effect on the early outcomes of coronary artery bypass grafting.

About Authors

  • Alena V. Grishenok, Postgraduate; ORCID
  • Viktoriya Yu. Buziashvili, Сand. Med. Sci., Researcher; ORCID
  • Simon Т. Matskeplishvili, Dr. Med. Sci., Professor, Corresponding Member of RAS, Chief Researcher; ORCID
  • Evgeniy P. Golubev, Сand. Med. Sci., Researcher; ORCID
  • Olga M. Sherstyannikova, Сand. Med. Sci., Researcher; ORCID
  • Sofya L. Gvaliya, Postgraduate; ORCID
  • Yuriy I. Buziashvili, Dr. Med. Sci., Professor, Academician of RAS, Head of Clinical Diagnostic Department; ORCID

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