title: Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction.
abstract: BACKGROUND
  The optimal treatment strategies for acute ST-elevation myocardial infarction (STEMI) in older patients are unclear because of the high risk of mortality in this population. Hypoalbuminemia, frailty, and body mass index (BMI) have been reported to worsen the prognosis of some older patients with cardiovascular disease, but the specific impact of these factors on the prognosis after STEMI is poorly understood. The aim of this study was to investigate the impact of these factors on early outcomes in patients aged ≥85 years with acute STEMI.
  
  
  METHODS
  Sixty-two consecutive eligible patients aged ≥85 years (mean age, 88.1±2.5 years; age range, 85-94 years; female, 41.9%; primary percutaneous coronary intervention, 67.7%) who were admitted to our hospital with STEMI were retrospectively reviewed. Baseline patient characteristics, echocardiographic, electrocardiographic, and laboratory findings, and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) score were assessed. The primary endpoint was in-hospital mortality and the secondary endpoint was failure of discharge to home. Independent baseline variables with a p-value of <0.15 in the univariate analyses were included in the multivariate analyses.
  
  
  RESULTS
  Multivariate analysis identified a higher baseline serum troponin I level [p=0.046; odds ratio (OR): 1.02], lower baseline albumin level (p=0.035, OR: 0.16), and CSHA-CFS score ≥6 (p=0.028, OR: 6.38) as independent predictors of in-hospital mortality. Lower BMI (p<0.001, OR: 0.49) and CSHA-CFS frailty score ≥6 (p=0.002, OR: 16.69) were identified as independent predictors of failure of discharge to home.
  
  
  CONCLUSIONS
  These findings indicate that the serum albumin level, CSHA-CFS score, and BMI, in addition to serum troponin I level, have an impact on the early prognosis of older patients with STEMI.
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Yasumori
authors.initials: Y
authors.lastname: Sujino
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tanno
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan. Electronic address: snakano@saitama-med.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Funada
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Hosoi
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Senbonmatsu
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D016330:Frail Elderly; D017052:Hospital Mortality; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I
keywords: Body mass index; Frailty; Hypoalbuminemia; In-hospital mortality; ST-elevation myocardial infarction