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. 2019 Aug 16;11(8):e5399.
doi: 10.7759/cureus.5399.

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Rupak Desai  1 , Alok R Amraotkar  2 , Melissa G Amraotkar  3 , Samarthkumar Thakkar  4 , Hee Kong Fong  5 , Yash Varma  6 , Nanush Damarlapally  7 , Rajkumar P Doshi  8 , Kishorbhai Gangani  9
Affiliations

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Rupak Desai et al. Cureus. .

Abstract

Objective To study the impact of frailty on inpatient outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods The National Inpatient Sample data of all PCI-related hospitalizations throughout the United States (US) from 2010 through 2014 was utilized. Patients were divided into two groups: frailty and no-frailty. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to stratify groups and outcomes. In order to address the substantial difference in the total number of valid observations between the two groups, a propensity-matched analysis was performed at a 1:1 ratio and caliper width of 0.01. Results A total of 2,612,661 PCI-related hospitalizations throughout the US from 2010 through 2014 were identified, out of which 16,517 admissions (0.6%) had coexisting frailty. Only 1:1 propensity-matched data was utilized for the study. Propensity-matched frailty group (n=14,717) as compared to no-frailty (n=14,755) was frequently older, white, and Medicare enrollee (p<0.05). The frailty group had significantly higher rates of comorbidities and complications (p<0.05). All-cause in-hospital mortality was higher in the no-frailty group (p<0.05). Age, white race, non-elective admission, urban hospitals, and comorbidities predicted in-hospital mortality in frailty group (p<0.05). Rheumatoid arthritis, depression, hypertension, obesity, dyslipidemia, and history of previous PCI decreased odds of in-hospital mortality in frailty group (p<0.05). Frailty group had prolonged hospital stay and higher hospital charges (p<0.05). Conclusions Frailty has a significant effect on PCI-related outcomes. We present a previously unknown protective effect of cardiovascular disease risk factors and other health risk factors on frail patients undergoing PCI. Frailty's inclusion in risk stratification will help in predicting the post-procedure complications and improve resource utilization.

Keywords: all-cause mortality; cardiovascular outcomes; frailty.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Standardized Differences in Data Before and After 1:1 Propensity Matching
Std. Difference = Standardized Differences
Figure 2
Figure 2. Inpatient Outcomes in Frailty versus No-Frailty Patients Undergoing Percutaneous Coronary Intervention From 1:1 Propensity Matched Data
PCI = Percutaneous Coronary Intervention p-value <0.05 indicates statistical significance
Figure 3
Figure 3. Multivariable Predictors of Inpatient Mortality in Frailty Patients From 1:1 Propensity Matched Data
CABG = Coronary Artery Bypass Graft, CI = Confidence Interval, OR = Odds Ratio, MI = Myocardial Infarction, P = p-value, PCI = Percutaneous Coronary Intervention p-value <0.05 indicates statistical significance
See this image and copyright information in PMC

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