Frailty Predicts Poor Prognosis of Patients After Percutaneous Coronary Intervention: A Meta-Analysis of Cohort Studies

Abstract

Background: Frailty has been related to a higher risk of cardiovascular events, while the association between frailty and outcomes for patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains unclear. We performed a meta-analysis of cohort studies to evaluate the above association.Methods: Cohort studies aiming to determine the potential independent association between frailty and clinical outcomes after PCI were identified by search of PubMed, Embase, and Web of Science databases from inception to February 22, 2021. A random-effects model that incorporates the possible heterogeneity among the included studies was used to combine the results.Results: Ten cohort studies with 7,449,001 patients were included. Pooled results showed that frailty was independently associated with higher incidence of all-cause mortality [adjusted risk ratio (RR) = 2.94, 95% confidence intervals (CI): 1.90–4.56, I2 = 56%, P < 0.001] and major adverse cardiovascular events [(MACEs), adjusted RR = 2.11, 95% CI: 1.32–3.66, I2 = 0%, P = 0.002]. Sensitivity analyses limited to studies including elderly patients showed consistent results (mortality: RR = 2.27, 95% CI: 1.51–3.41, I2 = 23%, P < 0.001; MACEs: RR = 2.44, 95% CI: 1.44–4.31, I2 = 0%, P = 0.001). Subgroup analyses showed that characteristics of study design, follow-up duration, or type of PCI did not seem to significantly affect the associations (P-values for subgroup analyses all >0.05).Conclusions: Frailty may be an independent risk factor of poor prognosis for patients with CAD after PCI.

Complex Percutaneous Coronary Intervention Outcomes in Older Adults

“…Although the observational study design cannot account for unmeasured confounders, it is nonetheless notable that the study groups were not statistically different across predictors of poor PCI outcomes in older adults, including frailty. 27 , 28 Therefore, the baseline characteristics between PCI groups suggest that simple differences in comorbid disease burden are unlikely to be the culprit. Furthermore, the risk of all‐cause death was actually amplified in adjusted analyses.…”

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

“…A meta-analysis by He et al [ 40 ] in 2022, with nine studies and a cohort of 2658 patients, showed that the occurrence of frailty was between 12.5% and 27.8% and correlated with higher in-hospital [odds ratio (OR) = 3.59, 95%CI: 2.01-6.42, I 2 = 35%], short-term (OR = 6.61, 95%CI: 2.89-15.16, I 2 = 0%), as well as long-term mortality (HR = 3.24, 95%CI: 2.04- 5.14, I 2 = 70%) of PCI patients. A meta-analysis by Wang et al [ 41 ] in 2021 demonstrated an independent positive association of frailty and all-cause mortality (adjusted RR = 2.94, 95%CI: 1.90–4.56, I 2 = 56%, P < 0.001) and MACEs (adjusted RR = 2.11, 95%CI: 1.32–3.66, I 2 = 0%, P = 0.002). Similarly, a meta-analysis of six studies by Yu et al [ 42 ] in 2023 reported higher rates of all-cause mortality (HR= 2.29, 95%CI: 1.65–3.16, P = 0.285), rehospitalization (HR = 2.53, 95%CI: 1.38–4.63), and in-hospital major bleeding (HR = 1.93, 95%CI: 1.29–2.90, P = 0.825) in PCI cohort.…”

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

“…19,20 Frailty is consistently found to be related to poor outcomes of numerous cardiovascular conditions and procedures. 21,22 Among methods for its assessment, the frailty phenotype collects data that may not be readily available, the frailty index requires a multidisciplinary team, and the clinical frailty scale (CFS) contains many impression-based components. [23][24][25] BI is widely used to evaluate physical functional ability, is easy to implement, and, with adequate training, has demonstrated very high reliability.…”