Invasive strategy and frailty in very elderly patients with acute coronary syndromes

Llaó, Isaac; Arizá-Solé, Albert; Sanchís, Juan; Alegre, Oriol; López-Palop, Ramón; Formiga, Francesç; Marı́n, Francisco; Vidán, María Teresa; Martínez‐Sellés, Manuel; Sionís, Alessandro; Vives‐Borrás, Miquel; Gómez‐Hospital, Joan Antoni; Gómez‐Lara, Josep; Roura, Gerard; Díez‐Villanueva, Pablo; Núñez‐Gil, Iván J.; Maristany, Jaume; Asmarats, Lluís; Bueno, Héctor; Abu‐Assi, Emad; Cequier, Ángel

doi:10.4244/eij-d-18-00099

Cited by 51 publications

(46 citation statements)

References 21 publications

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“…Many studies around the world have reported a high prevalence of frailty in older patients with ACS, from around 30% to 49%. 10,28,30,[43][44][45][46] However, when compared with studies using similar frailty definition, the prevalence of frailty in our study was higher. In the study conducted by Graham et al in 183 patients with ACS aged ≥65 in Canada, the prevalence of frailty was 30.5% using the Edmonton Frailty Scale.…”

Section: Discussioncontrasting

confidence: 78%

Frailty in Older Patients with Acute Coronary Syndrome in Vietnam

Nguyen¹,

Le²,

Tran³

et al. 2019

CIA

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Background: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41-1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32-3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24-4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35-6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59-6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38-4.63). Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.

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Section: Discussioncontrasting

confidence: 78%

Frailty in Older Patients with Acute Coronary Syndrome in Vietnam

Nguyen¹,

Le²,

Tran³

et al. 2019

CIA

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“…Whereas a conservative management was associated with worse outcome in nonfrail patients, this did not occur in frail patients. 31 Similar results were reported by Sanchis et al, 32 who randomized 106 elderly patients with ACS to a routine invasive or a selective invasive strategy. Patients enrolled had to have at least 2 requisites to be considered comorbid patients (peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure, or anemia).…”

Section: Discussionsupporting

confidence: 75%

“…Whereas a conservative management was associated with worse outcome in nonfrail patients, this did not occur in frail patients. 31 …”

Section: Discussionmentioning

confidence: 99%

Residual SYNTAX Score and One-Year Outcome in Elderly Patients With Acute Coronary Syndrome

et al. 2020

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Background: The residual burden of coronary artery disease after percutaneous coronary intervention (PCI) has been associated with worse ischemic outcome. However, data are conflicting in elderly patients. The aim of our study was to verify the incremental value of the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (rSS) over clinical variables and baseline SYNTAX score (bSS) in predicting 1-year mortality or cardiovascular events. Methods: A post hoc analysis of data collected in the Elderly-ACS 2 multicenter randomized trial was performed. We included 630 patients aged > 75 years with multivessel coronary disease undergoing CJC Open 2 (2020) 236e243

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“…The LONGEVO-SCA registry included NSTE-ACS patients >80 years while a geriatric assessment during the first 72 hours of hospitalization 26 was conducted. Of 531 patients, 27.3% were frail, 76.6% of all patients underwent invasive assessment.…”

Section: Discussionmentioning

confidence: 99%

Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome

Rittger¹,

Stadelmaier²,

Kieschnick³

et al. 2020

CIA

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Introduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients >75 years of age. Methods and Results: Consecutive patients >75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, "timed up and go" test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9±5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9±4.7 years vs 83.5±6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤2 at baseline, IADL ≤7, CFS ≥7 and age ≥85 years, significantly predicted conservative treatment. Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.

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Invasive strategy and frailty in very elderly patients with acute coronary syndromes

Abstract: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.

Cited by 51 publications

References 21 publications

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Residual SYNTAX Score and One-Year Outcome in Elderly Patients With Acute Coronary Syndrome

<p>Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome</p>

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