Bleeding Risk Scores and Scales of Frailty for the Prediction of Haemorrhagic Events in Older Adults with Acute Coronary Syndrome: Insights from the FRASER study

Pavasini, Rita; Maietti, Elisa; Tonet, Elisabetta; Bugani, Giulia; Tebaldi, Matteo; Biscaglia, Simone; Cimaglia, Paolo; Serenelli, Matteo; Ruggiero, Rossella; Vitali, Francesco; Galvani, Marcello; Minarelli, Monica; Rubboli, Andrea; Bernucci, Davide; Volpato, Stefano; Campo, Gianluca

doi:10.1007/s10557-019-06911-y

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…The present analysis was carried out by using the data of the populations of two different studies. The first one was the “Frailty in Elderly Patients Receiving Cardiac Interventional Procedures” (FRASER) study (NCT02386124) [ 14 , 15 , 16 ]. In brief, this multicentre, observational, prospective study analysed the frailty status of 402 adults aged ≥ 70 years admitted to four Italian hospitals, with a diagnosis of ACS [ 14 , 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The first one was the “Frailty in Elderly Patients Receiving Cardiac Interventional Procedures” (FRASER) study (NCT02386124) [ 14 , 15 , 16 ]. In brief, this multicentre, observational, prospective study analysed the frailty status of 402 adults aged ≥ 70 years admitted to four Italian hospitals, with a diagnosis of ACS [ 14 , 15 , 16 ]. The second one was the “Physical Activity Intervention for Patients with Reduced Physical Performance After Acute Coronary Syndrome” (HULK) study (NCT03021044) [ 17 , 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

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Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Pavasini

Tebaldi

Bugani

et al. 2021

JCM

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Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Pavasini

Tebaldi

Bugani

et al. 2021

JCM

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“…Currently, guidelines include scores supporting clinicians for assessing intensity and duration of antithrombotic therapy, but these tools do not consider important factors such as frailty and disability. However, recently published data from a small cohort of patients, showed that frailty or physical performance scales were able to discriminate the occurrence of bleeding events, but when integrated with bleeding scores did not result in any clinically meaningful improvement in the prediction of bleedings [8]. Furthermore, bleeding scores mentioned probably overweight agerelated patient bleeding risk [9].…”

Section: Prevalence and Incidence Of Coronary Artery Disease In Elderlymentioning

confidence: 98%

Antithrombotic therapy in acute coronary syndrome: undertreatment of elderly?

Muraca

Ciatti

Migliorini

et al. 2020

Monaldi Arch Chest Dis

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The appropriate use of dual antiplatelet therapy (DAPT) in elderly patients with acute coronary syndrome (ACS) is largely debated. Due to the "demographic transition" in western countries, the elderly represent a growing percentage of patients admitted to hospitals for ACS, and among this high risk setting population most of early and late adverse outcomes occur. The presence of several concomitant “comorbidities” complicate the management strategy of both medical or invasive treatment and the clinical decision making process is challenging. Moreover, elderly people are constantly underrepresented in clinical trials and studies. As a result, there is no specific evidence about the optimal antithrombotic therapy in elderly and no specific recommendations are mentioned in the current ACS guidelines. Currently, the best practice for old people is still rudimentary and principally extrapolated from general cardiovascular guidelines. The management of elderly patients should be based on the evaluation of ischemic and hemorrhagic risk, life expectancy, comorbidities and parameters that are not included in the scores recommended by the current guidelines such as frailty and disability. In the era of “precision medicine”, the evaluation of bleeding and ischaemic risk in elderly patients must be a dynamic process because of the risk changing over time. A“tailored therapy by individualized medicine” is the key of management strategy.

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“…[ 68 ] A number of scales for frailty or physical performance (Short Physical Performance Battery, Rockwood Clinical Frailty Scale, Columbia Frailty Index and the Edmonton Frail Scale) may predict the occurrence of major bleeding while on DAPT, although the APSC does not endorse the use of any particular scoring system for frailty. [ 69 ]…”

Section: Elderly Patientsmentioning

confidence: 99%

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

et al. 2021

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Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy.

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Bleeding Risk Scores and Scales of Frailty for the Prediction of Haemorrhagic Events in Older Adults with Acute Coronary Syndrome: Insights from the FRASER study

Cited by 15 publications

References 28 publications

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Antithrombotic therapy in acute coronary syndrome: undertreatment of elderly?

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

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