C-35 | The Effect of Frailty on Patient Outcomes After Percutaneous Coronary Intervention of Chronic Total Occlusion

Frail individuals have increased vulnerability to adverse events. Chronic total occlusions (CTO) are predominantly found in the advanced age population. We determined the outcomes of percutaneous coronary intervention (PCI) of CTO in frail individuals and its impact on 30-day readmission (30-DRr) and healthcare utilization in the United States. Using the 2016-2020 National Readmission Database and International Classification of Diseases, 10th revision (ICD-10) codes, patient admissions with CTO were analyzed. Readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index, for patients discharged alive. Frailty was determined using the Gilbert Frailty Risk Index. The primary outcome was 30-DRr, while secondary outcomes were complications, inpatient mortality rate, length of stay, and resource utilization defined by hospital charge (HC). Outcomes were analyzed to compare frail and non-frail individuals. A total of 60,981 index hospitalizations for PCI of CTO were identified. There were 12,376 (20.3%) frail individuals identified. The mean age on index admission was 65.8 ± 11 for non-frail and 70.1 ± 10.6 years for frail, 65.2% (39,760) were male. The 30-DRr was 14.1% for frail patients vs 7.83% for non-frail patients (OR 1.16, 95% CI 1.04-1.29, p=0.008). Frail patients had significantly higher rates of post-procedural complications including cardiac arrest and arrhythmias (p<0.05 for all). There were also significant increases in inpatient mortality (OR 2.60, CI 1.69-3.99), length of stay (OR 2.40, CI 2.24-2.57) and total HC for frail patients (p<0.001 for all). Our study highlights that frailty plays a crucial role in patient outcomes and procedural success. PCI of CTO has been shown to have substantial and sustained benefits in those with chronic coronary disease. Given the positive impact of intervention on health status, the predisposition of frailty in this population requires further studies on interventions and practices to minimize unfavorable outcomes.