Combined assessment of frailty and nutritional status can be a prognostic indicator after percutaneous coronary intervention

Noike, Ryota; Amano, Hideo; Hirano, Shojiro; Tsubono, Masakazu; Kojima, Yoshiyuki; Oka, Yoshitomo; Aikawa, Hiroto; Matsumoto, Shingo; Yabe, Takayuki; Ikeda, Takanori

doi:10.1007/s00380-022-02176-y

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…Eleven studies were retrospective cohorts[ 13 , 14 , 16 - 18 , 20 , 21 , 23 , 24 , 27 , 32 ], six were prospective cohorts[ 15 , 19 , 22 , 28 , 29 , 33 ], and four were cross-sectional studies[ 25 , 26 , 30 , 31 ]. Studies were conducted between 2015 and 2023, in various countries, and investigated the correlation between frailty and cardiovascular outcomes in different cardiac patient populations.…”

Section: Resultsmentioning

confidence: 99%

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Wang,

Liu

2024

World J Clin Cases

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BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention (PCI). However, how frailty affects clinical outcomes in this group is unclear. AIM To assess the link between frailty and the outcomes, such as in-hospital complications, post-procedural complications, and mortality, in elderly patients post-PCI. METHODS The PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were screened for publications up to August 2023. The primary outcomes assessed were in-hospital and all-cause mortality, major adverse cardiovascular events (MACEs), and major bleeding. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included. Frailty was consistently associated with adverse outcomes. Frail patients had significantly higher risks of in-hospital mortality [risk ratio: 3.45, 95% confidence interval (95%CI): 1.90-6.25], all-cause mortality [hazard ratio (HR): 2.08, 95%CI: 1.78-2.43], MACEs (HR: 2.92, 95%CI: 1.85-4.60), and major bleeding (HR: 4.60, 95%CI: 2.89-7.32) compared to non-frail patients. CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality, development of MACEs, and major bleeding in elderly individuals undergoing percutaneous coronary intervention.

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Section: Resultsmentioning

confidence: 99%

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Wang,

Liu

2024

World J Clin Cases

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“…This may be attributable in differences in measurement tools, region-specific disease burden of comorbidities, and access to healthcare, resources, and support systems for the older adult population. A recent study on a cohort of patients with stable chest pain undergoing PCI reports that CFS and nutritional assessment are important long-term prognostic indicators [45]. The onset of combined frailty and malnourishment in the post-PCI setting is emphasized.…”

Section: Discussionmentioning

confidence: 99%

Combined nutritional and frailty screening improves assessment of short-term prognosis in older adults following percutaneous coronary intervention

Mangalesh¹,

Daniel²,

Dudani³

et al. 2023

Coronary Artery Disease

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Background Frailty and malnutrition are well-known factors influencing outcomes of myocardial infarction (MI) in older adults. Due to considerable overlap between both entities, whether the simultaneous assessment of frailty and nutrition adds nonredundant value to risk assessment is unknown. Methods We performed a prospective cohort study on 402 patients aged at least 65 years diagnosed with ST-elevation MI that underwent percutaneous coronary intervention. Nutritional status was assessed by Controlling Nutritional Status score (CONUT), Prognostic Nutritional Index, and Geriatric Nutritional Response Index. Frailty was assessed by Clinical Frailty Scale (CFS), Derby frailty index, and acute frailty network. Primary outcome was major adverse cardiac events (MACE), comprising all-cause mortality, non-fatal MI, and unplanned repeat revascularization during 28-day follow-up. Increment in Global Registry of Acute Coronary Events (GRACE) score performance following the addition of nutrition and frailty was assessed. Results The incidence of MACE was 8.02 (6.38–9.95) per 1000 person-days. The CONUT score and CFS were the best predictors of MACE and independent predictors in the multivariate Cox-regression models [hazard ratios, 2.80 (1.54–5.09) and 2.54 (1.50–4.29)]. CONUT score classified 151 (37.6%) patients as malnourished, and CFS classified 131 (32.6%) as frail. The addition of both CONUT and CFS to the GRACE score led to better model discrimination and calibration through improved c-statistic (+0.165) (P < 0.0001) and Akaike and Bayesian information criteria. Conclusion Combining CONUT and CFS provides nonredundant prognostic value despite their overlapping nature. Combined nutritional and frailty screening may improve risk prognostication in older adults following MI.

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“…Post-percutaneous coronary intervention patients should be evaluated if they suffer from of combined frailty and malnutrition. This work suggests a perspective to evaluate and treat patients with frailty while monitoring their heart disease, and if they should undergo PCI [146].…”

Section: Prospectivementioning

confidence: 99%

Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures

Soto

Pérez-Torres

Rubio-Ruiz

et al. 2023

IJMS

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Frailty is a global health problem that impacts clinical practice. It is complex, having a physical and a cognitive component, and it is the result of many contributing factors. Frail patients have oxidative stress and elevated proinflammatory cytokines. Frailty impairs many systems and results in a reduced physiological reserve and increased vulnerability to stress. It is related to aging and to cardiovascular diseases (CVD). There are few studies on the genetic factors of frailty, but epigenetic clocks determine age and frailty. In contrast, there is genetic overlap of frailty with cardiovascular disease and its risk factors. Frailty is not yet considered a risk factor for CVD. It is accompanied by a loss and/or poor functioning of muscle mass, which depends on fiber protein content, resulting from the balance between protein breakdown and synthesis. Bone fragility is also implied, and there is a crosstalk between adipocytes, myocytes, and bone. The identification and assessment of frailty is difficult, without there being a standard instrument to identify or treat it. Measures to prevent its progression include exercises, as well as supplementing the diet with vitamin D and K, calcium, and testosterone. In conclusion, more research is needed to better understand frailty and to avoid complications in CVD.

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Combined assessment of frailty and nutritional status can be a prognostic indicator after percutaneous coronary intervention

Cited by 6 publications

References 37 publications

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Impact of frailty on outcomes of elderly patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Combined nutritional and frailty screening improves assessment of short-term prognosis in older adults following percutaneous coronary intervention

Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures

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