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. 2022 May 16;2(3):oeac035.
doi: 10.1093/ehjopen/oeac035. eCollection 2022 May.

Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management

Hanna Ratcovich  1 , Benjamin Beska  1 , Greg Mills  1 , Lene Holmvang  2 , Jennifer Adams-Hall  3 , Hannah Stevenson  4 , Murugapathy Veerasamy  5 , Chris Wilkinson  3 , Vijay Kunadian  1
Affiliations

Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management

Hanna Ratcovich et al. Eur Heart J Open. .

Abstract

Aim: Frailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown.

Methods and results: The multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23-4.02, P = 0.008; Fried: HR 1.81, 95% CI 1.00-3.27, P = 0.048].

Conclusion: In older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years.

Registration: Clinicaltrials.gov NCT01933581.

Keywords: Acute coronary syndrome; Ageing; Frailty; NSTEACS.

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Figures

Graphical abstract
Graphical abstract
Pictures from Servier Medical Art Image Bank.
Figure 1
Figure 1
Kaplan–Meier of the composite primary endpoint by frailty category: (A) clinical frailty scale and (B) Fried criteria. CFS, clinical frailty scale.
Figure 2
Figure 2
Kaplan–Meier of 5-year all-cause mortality by frailty category: (A) clinical frailty scale and (B) Fried criteria. CFS, clinical frailty scale.
None
See this image and copyright information in PMC

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