Impact of Frailty and Age on Clinical Outcomes in Patients Who Underwent Endovascular Therapy

Abstract

Purpose: Information on the relationship between frailty and the outcome of endovascular therapy (EVT) in elderly patients with lower extremity peripheral artery disease (PAD) is scarce. This study aimed to reveal the impact of frailty on the prognosis of super-elderly patients who underwent EVT. Materials and Methods: From August 2015 to August 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we categorized 323 patients into 4 groups according to age and the presence or absence of frailty as follows: elderly with frailty (age ≥ 75, Clinical Frailty Scale [CFS] ≥ 5), elderly without frailty (age ≥ 75, CFS ≤ 4), young with frailty (age < 75, CFS ≥ 5), and young without frailty (age < 75, CFS ≤ 4); we analyzed them accordingly. The primary endpoints were major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation, and revascularization. The secondary endpoint was cardiovascular death. Results: The median follow-up period was 2.7 years. In the elderly with frailty, elderly without frailty, young with frailty, and young without frailty groups, the freedom rates from MACLE were 34.9%, 55.7%, 35.4%, and 63.0%, respectively (p<0.001) and from all-cause death were 43.5%, 73.4%, 50.7%, and 90.9%, respectively (p<0.001). The freedom rates from MACLE were significantly higher among elderly patients with frailty than among young patients without frailty (55.7% vs 35.4%, p=0.01). In multivariate analysis, frailty was independently associated with MACLE incidence. Conclusion: Frailty as defined by CFS might be a predictor of MACLE incidence in patients with PAD who underwent EVT. By considering treatment indications for patients with PAD by focusing on frailty rather than age, we may examine whether EVT policies are appropriate and manage patient and caregiver expectations for potential improvement in functional outcomes. Further studies are expected to investigate whether changes in frailty after EVT change prognosis.

Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry

“…Cox regression analysis was performed to test the prognostic significance of complete revascularization for MACE. CR was adjusted by clinically important variables reported by previous studies [ 18 – 22 ]. A P value < 0.05 was considered statistically significant in all analyses.…”

“…Baseline characteristicsData are shown as median [interquartile range], or n (percentage) CVD cerebrovascular disease, CLTI chronic limb threatening ischemia, LVEF left ventricular ejection fraction, ABI ankle-brachial index, eGFR estimated glomerular filtration rate, CRP C-reactive protein, BNP brain natriuretic peptide, LDL-C low density lipoprotein cholesterol, HDL-C high density lipoprotein cholesterol, TG triglyceride Cox regression analysis was performed to test the prognostic significance of complete revascularization for MACE. CR was adjusted by clinically important variables reported by previous studies[18][19][20][21][22]. A P value < 0.05 was considered statistically significant in all analyses.…”

Status and influencing factors of frailty in patients with restenosis after percutaneous transluminal angioplasty for peripheral arterial disease: A cross-sectional study

“…[13] There have been studies on cardiovascular events and the prognosis of patients with peripheral arterial diseases caused by debilitation. [14,15] However, studies on frailty in China are still in the initial stage, and most of the subjects are elderly individuals in institutions and the community. There are few studies on frailty and its influencing factors in restenosis patients.…”