Hendrich II frailty score ≥5 independently predicted in-hospital mortality after ACS PCI with OR 11.2, combined model AUC 0.95 for risk stratification.
Does patient frailty, measured by the Hendrich II score, predict in-hospital mortality in ACS patients undergoing PCI?
The Hendrich II score, a readily available measure of frailty, is a strong independent predictor of in-hospital mortality in ACS patients undergoing PCI.
Abstract Background Patient frailty may have an important impact on outcomes in PCI for acute coronary syndrome (ACS). The Hendrich II score is an objective measure of frailty that is derived routinely by many institutions as part of standard of care to assess for one component of frailty, the fall risk. We analyzed the potential utility of this readily available scoring tool to predict in-hospital mortality in an elderly population undergoing PCI for ACS. Methods This retrospective analysis incorporated key variables: age, PCI indication, dialysis, left ventricular ejection fraction (LVEF) 30%, cardiogenic shock, mechanical ventilation, and frailty utilizing the Hendrich II score. Unadjusted univariate analysis was performed followed by multivariate logistic regression to derive a model for prediction of in-hospital mortality. Results Consecutive ACS patients (n=602) undergoing PCI from 12/2018 to 12/2019 (n=602) had requisite data available. By univariate analysis, all key variables cited above except for PCI indication were associated with increased mortality (p0.05 for age, p0.001 for all others). Multivariable analysis revealed that cardiogenic shock (OR 484, 95% CI 91.6-5,163, p0.001), dialysis (OR 35.5, 95% CI 4.36-279, p=0.002), Hendrich II score ≥5 (OR 11.2, 95% CI 2.54-73.4, p=0.001), and age ≥80 years (OR 6.40, 95% CI 1.27-45.8, p=0.024) were associated with increased mortality. Modified Weighted Risk Scores (MWRS) were created (Figure 1). The usability of the scoring systems for risk stratification was evaluated based on predicted probabilities of mortality. The final regression model provided the best risk stratification with an Area Under the Curve (AUC) of 0.95. Conclusion Patient frailty proved to be an important, independent predictor of mortality in ACS PCI patients. Combining a widely used and readily available Frailty Score (the Hendrich II Score) with cardiogenic shock, dialysis and age provides an excellent predictive risk score for ACS PCI patients.MWRS in our study population
Sharma et al. (2025) studied this question. Hendrich II frailty score ≥5 independently predicted in-hospital mortality after ACS PCI with OR 11.2, combined model AUC 0.95 for risk stratification.