Phase Angle as a Reliable Biomarker of Frailty to Predict Postoperative Outcomes in Patients Undergoing Off-Pump Coronary Artery Grafting: A Prospective Observational Study

초록

Objective:<bold> </bold>To elucidate the association between phase angle (PA) and a composite adverse outcome in patients requiring off-pump coronary artery bypass grafting (OPCAB).Design: A prospective observational study.Setting:<bold> </bold>High-volume single center.Participants:<bold> </bold>A total of 229 adult patients who underwent OPCAB from May 2019 to October 2020.Interventions:<bold> </bold>Each patient underwent bioelectrical impedance analysis, including PA assessment before surgery (PA(pre)), immediately postoperatively (PA(post)), and 1 day postoperatively (PA(POD1)), using an Inbody S10. Frailty index and nutritional assessments also were obtained before surgery.Measurements and main results:<bold> </bold>Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, new-onset atrial fibrillation, acute kidney injury, stroke, postoperative pulmonary complications, wound complications, sepsis, reoperation, and/or delirium occurring during hospitalization and over the following year. Patients for whom composite adverse outcomes were reported had lower PA(pre) than those without complications (5.4 +/- 0.9 v 6.0 +/- 0.9, p < 0.001). The PA was significantly associated with in-hospital and 1-year composite postoperative outcomes. The odds ratios (OR, [95% confidence interval]) for PA(pre) by time were in-hospital complications (0.435 [0.314, 0.604], p < 0.001; 1-year complications: 0.459 [0.330, 0.638], p < 0.001) and PA(POD1) (OR, in-hospital complications: 0.400 [0.277, 0.576], 1-year complications: 0.429 [0.298, 0.619], p < 0.001). The PA(pre) was significantly associated with days alive and out of hospital until 1 year. The cut-off value of PA(pre) for optimal prediction of in-hospital complications was 6.0 (area under the curve: 0.691 [0.623-0.758], p < 0.001).Conclusion:<bold> </bold>Low PA as an indicator of frailty is associated with adverse postoperative outcomes after OPCAB. Low PA may be employed as a noninvasive and practical tool for the prediction of prognosis in patients with coronary artery disease.

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