Effects of Early Rehabilitation in Patients with Frailty Syndrome Undergoing Coronary Artery Bypass Grafting

Abstract

Aim. To evaluate the profile of postoperative complications and the dynamics of transthoracic echocardiography parameters, physical performance, and myocardial injury markers in patients with frailty syndrome in the perioperative period of coronary artery bypass grafting (CABG), depending on the chosen rehabilitation program. Materials and methods. The study included 80 patients with stable coronary artery disease, randomized into two groups. Patients in group 1 (early rehabilitation, n = 36) completed an early physical rehabilitation program on a treadmill lasting 14-18 days. Group 2 (control, n = 44) did not complete the early training program. Myocardial remodeling parameters using echocardiography and physical performance of the participants, assessed at days 5-6 and 21-23 after CABG, were analyzed. Additionally, the concentration of myocardial injury biomarkers, including N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin (IL) 33, and stimulating growth factor gene-derived 2 (ST2), as well as the incidence and nature of intraand postoperative complications were assessed. Results. The incidence of complications was 18% among patients who completed the early rehabilitation program and 48% in the control group ( p = 0.03). The odds of developing complications were significantly lower in patients who were engaged in the early training program compared to those who were not (OR 0.34; 95% CI 0.13-0.92; p = 0.03). Left ventricular ejection fraction decreased after surgery relative to baseline values both in group 1 ( p < 0.001) and in the control group ( p = 0.001). In the third week after CABG, patients with early rehabilitation showed a significant improvement in peak oxygen consumption ( p = 0.041) and exercise tolerance ( p < 0.001), as well as a decrease in NT-proBNP ( p = 0.009) and ST2 ( p = 0.002) levels. In the control group, either an increase in these parameters or persisting negative trends were observed. Conclusion. Data were obtained on the impact of early physical training on the postoperative disease course in patients with frailty syndrome undergoing CABG. The examination of changes in laboratory markers of myocardial damage and instrumental signs of myocardial remodeling was performed.