Key result
Preoperative clinical frailty was independently associated with a significantly higher risk of major adverse cardiovascular events (HR 4.27) in elderly patients with stable coronary artery disease after elective PCI.
Why the study?
There are few reports evaluating long-term clinical outcomes after PCI in patients with stable CAD complicated by frailty.
Does pre-PCI frailty increase the risk of major adverse cardiovascular events in elderly patients with stable CAD undergoing elective PCI?
Observational (n=239)
No
Does pre-PCI frailty increase the risk of major adverse cardiovascular events in elderly patients with stable CAD undergoing elective PCI?
Hazard Ratio: 4.27 (95% CI 1.86–9.8)
Absolute Event Rate: 48.3% vs 9.9%
p-value: p=<0.001
Preoperative frailty is a strong independent predictor of long-term major adverse cardiovascular events and major bleeding in elderly patients undergoing elective PCI for stable CAD.
May inform pre-PCI risk stratification in elderly stable CAD; extends observational frailty data but leaves causal impact open.
There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.
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Shimono et al. (2023) conducted an observational in Stable coronary artery disease (n=239). Preoperative clinical frailty (Clinical Frailty Scale ≥ 5) vs. Non-frail (Clinical Frailty Scale < 5) was evaluated on Major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization (HR 4.27, 95% CI 1.86-9.80, p=<0.001). Preoperative clinical frailty was independently associated with a significantly higher risk of major adverse cardiovascular events (HR 4.27) in elderly patients with stable coronary artery disease after elective PCI.
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