title: Frailty predicts major bleeding within 30days in elderly patients with Acute Coronary Syndrome.
abstract: OBJECTIVE
  Bleeding in ACS patients is an independent marker of adverse outcomes. Its prognostic impact is even worse in elderly population. Current bleeding risk scores include chronological age but do not consider biologic vulnerability. No studies have assessed the effect of frailty on major bleeding. The aim of this study is to determine whether frailty status increases bleeding risk in patients with ACS.
  
  
  METHODS
  This prospective and observational study included patients aged ≥75years admitted due to type 1 myocardial infarction. Exclusion criteria were severe cognitive impairment, impossibility to measure handgrip strength, cardiogenic shock and limited life expectancy due to oncologic diseases. The primary endpoint was 30-day major bleeding defined as a decrease of ≥3g/dl of haemoglobin or need of transfusion.
  
  
  RESULTS
  A total of 190 patients were included. Frail patients (72, 37.9%) were older, with higher comorbidity features and with a higher CRUSADE score at admission. On univariate analysis, frailty predicted major bleeding during 30-day follow-up despite less frequent use of a P2Y12 inhibitor (66.2% vs 83.6%, p=0.007) and decreased catheterisation rate (69.4% vs 94.1%, p<0.001). Major bleeding was associated with increased all-cause mortality at day 30 (18.2% vs 2.5%, p<0.001). On multivariate analysis, frailty was an independent predictor for major bleeding.
  
  
  CONCLUSIONS
  Frailty phenotype, as a marker of biological vulnerability, is an independent predictor of major bleeding in elderly patients with ACS. Frailty can play an important role in bleeding risk stratification and objective indices should be integrated into routine initial evaluation of these patients.
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain. Electronic address: Gonzalol.alonso@gmail.com.
authors: Gonzalo Luis
authors: GL
authors: Alonso Salinas
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Marcelo
authors: M
authors: Sanmartín Fernández
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Marina
authors: M
authors: Pascual Izco
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Álvaro
authors: Á
authors: Marco Del Castillo
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Luis Miguel
authors: LM
authors: Rincón Díaz
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Cristina
authors: C
authors: Lozano Granero
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: María
authors: M
authors: Valverde Gómez
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Pablo
authors: P
authors: Pastor Pueyo
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: David
authors: D
authors: Del Val Martín
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Ana
authors: A
authors: Pardo Sanz
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Juan Manuel
authors: JM
authors: Monteagudo Ruiz
authors: Department of Cardiology, Hospital Virgen Macarena, Doctor Fedriani Avenue, 3, 41007 Seville, Spain.
authors: Alejandro
authors: A
authors: Recio-Mayoral
authors: Department of Cardiology, Hospital de Merida, Antonio Campos Hoyos Avenue, 26, 06800 Merida (Badajoz), Spain.
authors: Luis
authors: L
authors: Salvador Ramos
authors: Department of Cardiology, Hospital de Merida, Antonio Campos Hoyos Avenue, 26, 06800 Merida (Badajoz), Spain.
authors: Domingo
authors: D
authors: Marzal Martín
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Asunción
authors: A
authors: Camino López
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: Manuel
authors: M
authors: Jiménez Mena
authors: Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
authors: José Luis
authors: JL
authors: Zamorano Gómez
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D018737:Hand Strength / Q000502:physiology; D006470:Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Acute Coronary Syndrome; Acute myocardial infarction; Elderly; Frailty; Major bleeding