Combination of the Barthel Index at Discharge with GRACE Leads to Improved One-Year Mortality Prediction in Older Patients with Acute Myocardial Infarction

Abstract

Purpose Many older patients with acute myocardial infarction (AMI) have impaired ability for activities of daily living (ADL). Impaired ADL leads to poor prognosis in elderly patients. The Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification in AMI patients but does not consider physical performance, which is an important prognosis predictor for older adults. This study assessed whether the Barthel Index (BI) score combine the GRACE score would achieve improved one-year mortality prediction in older AMI patients. Patients and Methods This single-center retrospective study included 688 AMI patients aged ≥65 years who were divided into an impaired ADL group (BI ≤60, n = 102) and a normal ADL group (BI >60, n = 586) based on BI scores at discharge. The participants were followed up for one year. Cox survival models were constructed for BI score, GRACE score, and BI score combined GRACE score for one-year mortality prediction. Results Patients had a mean age of 76.29 ± 7.42 years, and 399 were men (58%). A lower BI score was associated with more years of hypertension and diabetes, less revascularization, longer hospital stays, and higher one-year mortality after discharge. Multivariable Cox regression analysis identified BI as a significant risk factor for one-year mortality in older AMI patients (HR 0.977, 95% CI, 0.963–0.992, P = 0.002). BI (0.774, 95% CI: 0.731–0.818) and GRACE (0.758, 95% CI: 0.704–0.812) scores had similar predictive power, but their combination outperformed either score alone (0.810, 95% CI: 0.770–0.851). Conclusion BI at discharge is a significant risk factor for one-year mortality in older AMI patients, which can be better predicted by the combination of BI and GRACE scores.

Activities of daily living predict periprocedural myocardial infarction and injury following percutaneous coronary intervention: a cross-sectional study

“…It is widely acknowledged that higher ADL scores are strongly associated with better outcomes and fewer complications [ 35 ]. Impaired ADL has not only been associated with the incidence of cardiovascular diseases, such as heart failure and ACS, but also has been recognized as a prognostic factor for complications and long-term mortality in patients with these cardiovascular diseases [ 20 , 30 ]. This study found impaired ADL was an independent risk factor for periprocedural myocardial infarction and injury.…”

“…A 2-year follow-up study revealed that ADL assessment at hospital admission could be used for risk assessment in patients with acute coronary syndrome (ACS) and long-term treatment planning [ 19 ]. Another recent study demonstrated that ADL assessment at discharge was an independent risk factor for mortality in patients with acute myocardial infarction (AMI) [ 20 ]. However, the association between ADL and short-term complications of cardiovascular disease has not been thoroughly investigated.…”