Frailty is an independent prognostic marker in elderly patients with myocardial infarction

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2017-10, Vol.40 (10), p.925-931
• Main Authors: Alonso Salinas, Gonzalo Luis, Sanmartin, Marcelo, Pascual Izco, Marina, Rincon, Luis Miguel, Pastor Pueyo, Pablo, Marco del Castillo, Alvaro, Garcia Guerrero, Alberto, Caravaca Perez, Pedro, Recio‐Mayoral, Alejandro, Camino, Asuncion, Jimenez‐Mena, Manuel, Zamorano, José Luis
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome; Acute coronary syndromes; Acute Myocardial Infarction; Age; Age Factors; Aged; Aged, 80 and over; Aging; Chi-Square Distribution; Clinical Investigations; Comorbidity; Female; Frail Elderly; Frailty; Frailty - diagnosis; Frailty - epidemiology; Frailty - mortality; Health risk assessment; Heart attacks; Hemorrhage - epidemiology; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Multivariate Analysis; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Odds Ratio; Phenotype; Prevalence; Prognosis; Prospective Studies; Recurrence; Risk Factors; Spain - epidemiology; Tertiary Care Centers; Time Factors
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22749

Background Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age. Hypothesis: This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS. Methods Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively. Frailty was defined at admission using the previously validated Survey of Health Ageing and Retirement in Europe Frailty Index (SHARE‐FI) tool. The primary endpoint was the combination of death or nonfatal myocardial reinfarction during a follow‐up of 6 months. Major bleeding (hemoglobin decrease ≥3 g/dL or transfusion needed) and readmission rates were also explored. Results A total of 234 consecutive patients were included. Frail patients (40.2%) had a higher‐risk profile, based on higher age and comorbidities. On multivariate analysis, frailty was an independent predictor of the combination of death or nonfatal myocardial reinfarction (adjusted hazard ratio [aHR]: 2.54, 95% confidence interval [CI]: 1.12‐5.79), an independent predictor of the combination of death, nonfatal myocardial reinfarction, or major bleeding (aHR: 2.14, 95% CI: 1.13‐4.04), and an independent predictor of readmission (aHR: 1.80, 95% CI: 1.00‐3.22). Conclusions Frailty phenotype at admission is common among elderly patients with ACS and is an independent predictor for severe adverse events. It should be considered in future risk‐stratification models.