title: Barthel Index as a Predictor of 1-Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Higuchi
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kabeya
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taguchi
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Ishiguro
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Kohshoh
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D000367:Age Factors; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome