The role of frailty in older adults with Non-ST-elevation acute coronary syndrome: a Chinese population-based cohort study

OBJECTIVES: To investigate the risk factors for major adverse cardiovascular and cerebrovascular events (MACCE) and rehospitalization in older adults with non-ST-elevation acute coronary syndrome (NSTE-ACS) within one year after discharge. METHODS: This single-center prospective cohort study enrolled 528 patients, who were categorized into robust, pre-frail, and frail groups based on the FRAIL scale. Multivariate logistic regression analysis was used to identify factors influencing frailty or pre-frailty in these patients. Multivariate Cox regression analysis was performed to assess the factors associated with MACCE and rehospitalization in these patients and examine the prognostic differences among subgroups. RESULTS: The prevalence of frailty was 11.4%, and pre-frailty was 51.9%. Frailty was found to be an independent risk factor for MACCE (HR = 2.193, 95%CI 1.111-4.326, P = 0.024) and rehospitalization (HR = 1.906, 95%CI 1.031-3.522, P = 0.040) in older adults with NSTE-ACS. Subgroup analysis revealed that the old-old frailty group had a higher risk of MACCE compared to the old-old non-frailty group (HR = 2.389, 95%CI 1.072-5.322, P = 0.033), while no significant difference in MACCE risk was observed between the young-old frailty group and the old-old frailty group. The comorbid frailty group had a higher risk of rehospitalization than the comorbid non-frailty group (HR = 1.884, 95%CI 1.113-3.190, P = 0.018), but no significant difference in rehospitalization risk was found between the non-comorbid frailty group and the comorbid frailty group. CONCLUSIONS: Frailty is an independent risk factor for MACCE and rehospitalization in older adults with NSTE-ACS. Subgroup analysis further suggests that frailty maybe have greater impact on MACCE and rehospitalization in this population.