Frailty in Very Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Abstract

usage occurred in 58% of cases; the rest were bail-out procedures due to suboptimal initial balloon predilation. S-IVL was most commonly used in the left anterior descending coronary artery (50%), with 1.3 ± 0.5 stents implanted/target vessel. Angiographic success (<20% residual stenosis) occurred in all cases, with no procedural complications. Conclusion: S-IVL appears to be a useful modality in coronary calcium modification to optimise stent expansion. This device obviates the need for more complex lesion preparation strategies such as rotational atherectomy. Further study is warranted to compare different calcium modification devices with conventional balloon angioplasty.

Comparing health outcomes between coronary interventions in frail patients aged 75 years or older with acute coronary syndrome: a systematic review

“…The Hospital Frailty Risk Score (HFRS) used by Kwok et al [ 22 ] was developed and validated using broadly representative hospitalized cohorts [ 29 ]. Wong, Lee, and El-Jack [ 23 ] used the Essential Frailty Toolset (EFT) [ 30 , 31 ], which has been validated in older patients undergoing transcatheter aortic valve implantation and was recently used in a study of older patients who underwent CABG [ 30 ]. Llao et al [ 19 ] used the FRAIL scale [ 32 ], which has been validated against the Fried score [ 33 ], and has been shown to predict mortality risk in older ACS patients [ 34 ].…”

“…However, all ACS subtypes were represented across the included studies. STEMI patients were included in six studies [ 15 , 17 , 20 – 23 ], NSTEMI patients in all nine studies [ 15 , 17 – 24 ], and UA in four studies [ 18 , 19 , 22 , 23 ].…”

“…Alonso et al [ 15 ], Dodson et al [ 20 ], Llao et al [ 19 ], and Fishman et al [ 24 ] compared treatment differences between an invasive treatment and conservative treatment. Di Bari et al [ 17 ], Nunez et al [ 18 ], Wong, Lee, & El-Jack [ 23 ], and Damluji et al [ 21 ] compared outcomes between patients treated with PCI and patients who were not. The latter group included patients who did not undergo angiography and patients who underwent angiography but were not revascularized (either by PCI or CABG).…”

“…The primary outcome measures used in the remaining studies are generally accepted as measures of efficacy or effectiveness [ 6 , 13 , 36 ]. These included: in-hospital mortality (Kwok et al [ 22 ], Damluji et al [ 21 ]; medium-term (6-month) Death, MI or unplanned revascularization (Llao et al [ 19 ]); long-term (≥ 1 year) mortality (Di Bari et al [ 17 ]), Wong, Lee and El-Jack [ 23 ], and Fishman et al [ 24 ]); long-term death or MI (Alonso et al [ 15 ]); and long-term all-cause readmission (Nunez et al [ 18 ]).…”

“…For instance, items such as between-group comparisons in co-interventions were not reported in Di Bari et al [ 17 ], Kwok et al [ 22 ] and Nunez et al [ 18 ]. The risk of bias for Wong, Lee, and El-Jack [ 23 ] and Fishman et al [ 24 ] was not systematically evaluated, given that the abstracts did not contain enough information to make a judgement.…”