Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management
Why the study?
Frailty is associated with adverse outcomes in older ACS patients, but its impact on long-term clinical outcomes following invasive management of NSTEACS is unknown.
Does frailty increase the risk of long-term adverse clinical outcomes in older patients (≥75 years) undergoing invasive management for NSTEACS?
Population
263 patients aged >75 years undergoing coronary angiography following NSTEACS
Comparison
Frail vs pre-frail vs robust categorized by CFS and Fried criteria
Design
Multicentre prospective cohort study
Follow-up
5 years
Authors
Discussion
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Member takes
Implication
Frailty may identify higher long-term risk after angiography in older NSTEACS patients; leaves open whether interventions modify outcomes.
Key Points
- To determine the impact of baseline frailty on five-year adverse clinical outcomes in patients aged 75 years or older presenting with non-ST elevation acute coronary syndrome who undergo invasive coronary angiography.
- Multi-center interventional study (ICON-1, NCT01933581) of 263 patients aged >75 years undergoing coronary angiography following non-ST elevation acute coronary syndrome.
- Frailty was classified at baseline using both the Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and the Fried phenotype criteria, with follow-up through five years.
- The primary composite endpoint comprised all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding.
- According to CFS, the 5-year primary endpoint occurred in 66.7% (22/33) of frail, 53.3% (81/152) of pre-frail, and 34.6% (27/78) of robust patients (P = 0.003; age- and sex-adjusted HR 2.22, 95% CI 1.23–4.02, P = 0.008 vs. robust).
- According to Fried criteria, 5-year primary events occurred in 55.7% (39/70) of frail, 49.0% (72/147) of pre-frail, and 34.8% (16/46) of robust patients (P = 0.085; age- and sex-adjusted HR 1.81, 95% CI 1.00–3.27, P = 0.048 vs. robust).
Structured PICO
Does frailty increase the risk of long-term adverse clinical outcomes in older patients (≥75 years) undergoing invasive management for NSTEACS?
P
Population
263 patients aged >75 years undergoing coronary angiography following non-ST elevation acute coronary syndrome (NSTEACS)
I
Intervention
Frailty (assessed by Canadian Study of Health and Ageing Clinical Frailty Scale [CFS] and Fried criteria)
C
Comparator
Robust or pre-frail status (assessed by CFS and Fried criteria)
O
Outcome
Composite of all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding at 5 yearscomposite
In older patients (≥75 years) undergoing invasive management for NSTEACS, frailty is significantly associated with a higher risk of long-term adverse cardiovascular and bleeding events at 5 years.
Cite This Study
Ratcovich et al. (2022) studied this question.