A high Barthel Index (≥85) at discharge was associated with significantly lower 1-year mortality compared to a low Barthel Index (<85) in very elderly patients post-PCI for ACS (21% vs 62%; HR 0.25).
Cohort (n=91)
Does a high Barthel Index at discharge predict reduced 1-year mortality in very elderly patients undergoing PCI for ACS?
Activities of daily living at discharge, measured by the Barthel Index, is a strong predictor of 1-year mortality in very elderly patients (≥85 years) undergoing PCI for ACS.
Effect estimate: HR 0.25 (95% CI 0.11-0.57)
Absolute Event Rate: 21% vs 62%
p-value: p=0.001
BACKGROUND: Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated. HYPOTHESIS: Better ADL is associated with better 1-year prognosis. METHODS: This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI). RESULTS: In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval CI: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001). CONCLUSIONS: Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS.
Higuchi et al. (Thu,) conducted a cohort in Acute coronary syndrome (n=91). High Barthel Index (≥85) at discharge vs. Low Barthel Index (<85) at discharge was evaluated on 1-year mortality (HR 0.25, 95% CI 0.11-0.57, p=0.001). A high Barthel Index (≥85) at discharge was associated with significantly lower 1-year mortality compared to a low Barthel Index (<85) in very elderly patients post-PCI for ACS (21% vs 62%; HR 0.25).