Frailty is a short-term prognostic marker in acute coronary syndrome of elderly patients.
BACKGROUND
Frailty is a biological condition that reflects a state of decreased physiological reserve and vulnerability to stressors. The role of frailty in acute coronary syndrome patients has not been fully explored. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged ⩾75 years admitted for acute coronary syndrome.


METHODS
This prospective, observational study included patients aged ⩾75 years admitted due to type 1 myocardial infarction in four tertiary hospitals. Frailty was assessed by the SHARE-FI index. The primary endpoint was the combination of in-hospital death or non-fatal myocardial (re)infarction. Secondary endpoints included the assessment of individual rates of (re)infarction, mortality, stroke, major bleeding and the combination of in-hospital death, (re)infarction and mortality.


RESULTS
A total of 202 patients were analysed. Frail patients (n=71, 35.1%) were older, more often women, had higher rates of comorbidities, and a higher risk profile according to GRACE, TIMI and CRUSADE scores at admission. The primary endpoint was significantly more frequent among frail patients (9.9% vs. 1.5%; P=0.006), as well as the combination of death, myocardial infarction and stroke (11.3% vs. 1.5%; P=0.002), driven mainly by a higher mortality rate (8.5% vs 0.8%; P=0.004). On multivariate analysis, frailty phenotype was an independent predictor of major adverse cardiac events (odds ratio 7.13; 95% confidence interval 1.43-35.42).


CONCLUSIONS
Over one third of elderly patients with high-risk acute coronary syndrome are frail. Frailty phenotype is an important and independent prognostic marker in these patients.
Department of Cardiology, University Alcala de Henares, Spain Gonzalol.alonso@gmail.com.
Gonzalo Luis
GL
Alonso Salinas
Department of Cardiology, University Alcala de Henares, Spain.
Marcelo
M
Sanmartín Fernández
Department of Cardiology, University Alcala de Henares, Spain.
Marina
M
Pascual Izco
Department of Cardiology, Hospital 12 de Octubre, Spain.
Roberto
R
Martín Asenjo
Department of Cardiology, Hospital Virgen Macarena, Spain.
Alejandro
A
Recio-Mayoral
Department of Cardiology, Hospital de Mérida, Spain.
Luis
L
Salvador Ramos
Department of Cardiology, Hospital de Mérida, Spain.
Domingo
D
Marzal Martín
Department of Cardiology, University Alcala de Henares, Spain.
Asunción
A
Camino López
Department of Cardiology, University Alcala de Henares, Spain.
Manuel
M
Jiménez Mena
Department of Cardiology, University Alcala de Henares, Spain.
José Luis
JL
Zamorano Gómez
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000473:pathology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
Acute coronary syndrome; acute myocardial infarction; elderly; frailty