Frailty and Bleeding After Percutaneous Coronary Intervention

Kanenawa, Kenji; Yamaji, Kyohei; Tashiro, Hiroaki; Morimoto, Takeshi; Takahashi, Hiromasa; Hayashi, Masaomi; Hiramori, Seiichi; Tomoi, Yusuke; Kuramitsu, Shoichi; Domei, Takenori; Hyodo, Makoto; Ando, Kenji; Kimura, Takeshi

doi:10.1016/j.amjcard.2021.02.041

Cited by 8 publications

(7 citation statements)

References 20 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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“…Frailty is known to be associated with low LDL-C levels, which might explain the higher risk of admission for heart failure and subsequent cardiovascular mortalities. 31, 32 The strong relationship between low LDL-C levels and malignancy might also explain the higher non-cardiovascular mortality in patients with low LDL-C levels. 16 Since the risk of malignancy was higher than that of the general population due to overlapping risk factors for atherosclerosis and malignancy, 33, 34 systemic examination focusing on malignancy in patients with low LDL-C levels might be important in mitigating the non-cardiovascular death risks after PCI.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of baseline low-density lipoprotein cholesterol in patients undergoing coronary revascularization; A report from the CREDO-Kyoto registry

Kanenawa,

Yamaji,

Morimoto

et al. 2023

Preprint

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Background: The impact of very low baseline levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease remains unclear. Therefore, we aimed to investigate the baseline characteristics and clinical outcomes of patients with low baseline LDL-C levels who had undergone coronary revascularization. Methods: We enrolled 39439 patients of the pooled population from the CREDO-Kyoto registries Cohorts 1, 2, and 3. After excluding 6306 patients with missing baseline LDL-C data, the study population consisted of 33133 patients who had undergone their first coronary revascularization. We assessed the risk for mortality and cardiovascular events according to quintiles of the baseline LDL-C levels. Results: Patients in the very low LDL-C quintile (< 85 mg/dL) had more comorbidities than those in the other quintiles. Lower LDL-C levels were strongly associated with anemia, thrombocytopenia, and end-stage renal disease. The cumulative 4-year incidence of all-cause death increased as LDL-C levels decreased (very low: 19.4%, low: 14.5%, intermediate: 11.1%, high: 10.0%, and very high:9.2%; P<0.001), which was driven by both the early and late events. After adjusting for baseline characteristics, the adjusted risks of the very low and low LDL-C quintiles relative to the intermediate LDL-C quintile remained significant for all-cause death (very low: HR 1.29, 95% CI 1.16-1.44, P<0.001; low: HR 1.15, 95% CI 1.03-1.29, P=0.01). There were no significant interactions between the association of LDL-C level with all-cause death and subgroup factors, such as lipid-lowering treatment at index hospitalization, age, sex, acute myocardial infarction presentation, and study cohort. The excess adjusted risks of the lowest LDL-C quintile relative to the intermediate LDL-C quintile were significant for clinical outcomes such as cardiovascular death (HR 1.17, 95% CI 1.01-1.35), non-cardiovascular death (HR 1.35, 95% CI 1.15-1.60), sudden death (HR 1.44, 95% CI 1.01-2.06), and heart failure admission (HR 1.11 95% CI 1.01-1.22), while there was no excess risk for the lowest LDL-C quintile relative to the intermediate LDL-C quintile for myocardial infarction and stroke. Conclusions: Lower baseline LDL-C levels were associated with more comorbidities and a significantly higher risk of death, regardless of cardiovascular or non-cardiovascular causes, in patients who underwent coronary revascularization.

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“…Although previous studies have established that frailty defined by using CFS was associated with a poor prognosis of chronic heart failure [ 13 ] and acute coronary syndromes [ 14 ], only a few studies have investigated the clinical outcome and frailty with that of stable CAD patients who underwent elective PCI. Moreover, it has been reported that as the CFS increased, the patients at high bleeding risk (HBR) assessed by the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria [ 15 ] and the Japanese version of HBR (J-HBR) criteria [ 16 ] were also increased, and increasing major bleeding events [ 17 ]. We hypothesized that stable CAD patients who are frail, as assessed by CFS, would have poorer clinical outcomes including major bleeding events than stable CAD patients without frailty.…”

Section: Introductionmentioning

confidence: 99%

Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention

et al. 2023

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There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607–1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan–Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86–9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.

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Frailty and Bleeding After Percutaneous Coronary Intervention

Cited by 8 publications

References 20 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

Prognostic significance of baseline low-density lipoprotein cholesterol in patients undergoing coronary revascularization; A report from the CREDO-Kyoto registry

Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention

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