Impact of frailty on hospital adverse outcomes in elderly admitted with acute coronary syndrome

• Main Authors: Fernando Montenegro Sá, Fátima Saraiva, Francisco Soares, José Leite, João Morais
• Format: Article
• Language: English
• Published: Sociedade Galega de Medicina Interna 2020-01-01
• Series: Galicia Clínica
• Subjects: sindrome coronario agudo; anciano; fragilidad; prognostico
• Online Access: https://galiciaclinica.info/publicacion.asp?f=1741

Background: Frailty represents a complex clinical syndrome of decreased physiological reserve and increased vulnerability to stressors. Little is known regarding interaction between frailty status and outcomes in patients with acute coronary syndrome. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged &#8805; 75 years admitted for acute coronary syndromes. Methods: In this retrospective, single centre, observational study were included patients aged &#8805; 75 years admitted for acute coronary syndromes between January 2011 and December 2015. Frailty was assessed using the Fried criteria. The primary endpoint was all-cause in-hospital mortality. Secondary endpoints included the occurrence of re-infarction, stroke and major bleeding. Results: Of the 502 patients included, 126 were classified as frail. These patients were older (mean age 78±5.5 vs. 76.2±5.5 years; p=0.02), more often male (68.3%) and had a higher risk profile according to GRACE (151.4±18.8 vs. 132.1±16.8; p<0.0001), TIMI (4.3±1 vs. 3.1±1; p<0.001) and CRUSADE (34.6±9.4 vs. 25.8±9.5; p<0.001) scores at admission. All-cause in-hospital mortality was significantly more frequent in frail patients (11.9% vs. 5.6%; p<0.001), as well as re-infarction (7.4% vs. 4.8%; p<0.001), stroke (8.7% vs. 0.5%; p=0.002) and major bleeding (7.9% vs. 1.6%; p=0.002). On multivariate analysis, frailty remained independently associated with the primary endpoint (OR 5.63, [2.05-10.35]; p<0.001). Conclusion: Frailty, identified by Fried criteria, is frequent in elderly patients with acute coronary syndromes, and it is an independent prognostic predictor for in-hospital mortality.