Impact of frailty on outcomes in elderly patients with acute myocardial infarction who undergo percutaneous coronary intervention

Abstract

Aims Frailty is characterized by reduced biological reserves and weakened resistance to stressors, and is common in older adults. This study evaluated the prognostic implications of frailty at hospitalization in elderly patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI). Methods and results We prospectively analysed 546 AMI patients aged ≥80 years undergoing PCI from 2009 to 2017. Frailty was classified based on impairment in walking (unassisted, assisted, and wheelchair/non-ambulatory), cognition (normal, mildly impaired, moderately to severely impaired), and basic activities of daily living. Impairment in each domain was scored as 0, 1, or 2, and patients were categorized into the following three groups based on total score: no frailty (0), mild frailty (1–2), moderate-to-severe frailty (≥3). The median follow-up period was 589 days. Of the 546 patients, 27.8% were frail (mild or moderate-to-severe), and this proportion significantly increased to 35.5% at discharge (P < 0.001). Compared to non-frail patients, frail patients were older, less likely to be male, and had a higher rate of advanced Killip class. Major bleeding (no frailty, 9.6%; mild frailty, 16.9%; moderate-to-severe frailty, 31.8%; P < 0.001) and in-hospital mortality (no frailty, 8.4%; mild frailty, 15.4%; moderate-to-severe frailty, 27.3%; P < 0.001) increased as frailty worsened. After adjusting for confounders, frailty was independently associated with higher mid-term all-cause mortality (hazard ratio, 1.81; 95% confidence interval, 1.23–2.65; P = 0.002). Conclusion Frailty in AMI patients aged ≥80 years undergoing PCI was associated with major bleeding, in-hospital death, and mid-term mortality.

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

“…As evaluation of frailty based on conventional definitions such as gait speed and grip strength 5,15 are difficult during the acute phase of AMI because of safety concerns, we used a novel, simple definition of frailty created based on the Canadian Study on Health and Aging that includes measures of functional and cognitive performance in categorising the degree of frailty. 8,9,17 Our results suggest that additional treatments are needed to prevent progression of frailty as well as all-cause mortality in this population.…”

“…Recently, we and other investigators have shown that frailty status is associated with inhospital and mid-term mortality in patients with acute coronary syndrome. 9,15,16 However, there have been few reports about changes in frailty status, which we addressed in this study. This study demonstrated that more than 40% of nonagenarians with AMI undergoing PCI were frail at admission and the proportion of patients with frailty clearly increased during hospitalisation.…”

“…7 Frailty status was evaluated at admission and discharge according to the definition proposed by Dodson and colleagues. 8,9 Three domains of the frailty phenotype were evaluated: walking (0 ¼ unassisted, 1 ¼ assisted, and 2 ¼ wheelchair/non-ambulatory); cognition (0 ¼ normal, 1 ¼ mildly impaired, and 2 ¼ moderately to severely impaired); and basic ADLs, including eating, dressing, toileting, and bathing (0 ¼ independent in all ADLs, 1 ¼ partial assistance, and 2 ¼ full assistance). The total score was used to categorise patients into the following three groups: 0 (no frailty), 1 to 2 (mild frailty), and 3 or more (moderate to severe frailty).…”

“…The total score was used to categorise patients into the following three groups: 0 (no frailty), 1 to 2 (mild frailty), and 3 or more (moderate to severe frailty). 8,9 This assessment was performed by two or more trained raters with discrepancies resolved at a face-to-face meeting.…”

Prognostic Impact of Serum Albumin for Developing Heart Failure Remotely after Acute Myocardial Infarction

“…Hence, risk stratification for its prevention should be carried out in the early phase [ 2 , 3 , 4 , 5 ]. Previous reports have suggested a number of possible predictors of cardiovascular events after AMI, including patient background, electrocardiographic features, factors of reperfusion therapy including onset-to-balloon time, ventricular dysfunction, frailty, and poor nutritional status [ 6 , 7 , 8 ]. Serum albumin is one of the most important nutritional indicators.…”