Influence of Preadmission Frailty on Short- and Mid-Term Prognoses in Octogenarians With ST-Elevation Myocardial Infarction

Yoshioka, Naoki; Takagi, Kensuke; Morishima, Itsuro; Morita, Yasuhiro; Uemura, Yoshiko; Inoue, Yosuke; Umemoto, Norio; Shibata, Naoki; Negishi, Yosuke; Yoshida, Ruka; Tanaka, Akihito; Ishii, Hideki; Murohara, Toyoaki; investigators, N-registry

doi:10.1253/circj.cj-19-0467

Cited by 29 publications

(34 citation statements)

References 37 publications

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“…Both anemia and a low BMI have been identified as surrogate markers of frailty ( 29 , 31 ) in the elderly. Therefore, our findings may highlight the impact of frailty on the mid-term mortality, especially non-cardiac death, as previously reported by us ( 32 ).…”

Section: Discussionsupporting

confidence: 88%

The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction

et al. 2021

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Objective: The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era.Methods: Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated.Results: The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) (adjusted hazard ratio [HR], 0.048; 95% confidence interval [CI], 0.008-0.29; p<0.001), age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class ! II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (logtransformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030).Conclusion: This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.

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Section: Discussionsupporting

confidence: 88%

The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction

et al. 2021

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“…The mean ages of the included patients varied between 62 and 85 years, with proportions of males varying from 46 to 75%. Multiple tools were used for the evaluation of frailty among the included studies, including the Fried Frailty Criteria ( 15 , 17 ), the Canadian Study of Health and Aging Clinical Frailty Scale ( 16 , 22 ), validated frailty phenotype criteria ( 23 ), FRAIL scale ( 18 ), Claims-based Frailty Index ( 19 ), Safety Management Programme Score ( 20 ), Hospital Frailty Risk Score ( 24 ), and modified KATZ index ( 21 ). A total of 16,183 patients were considered with frailty at baseline.…”

Section: Resultsmentioning

confidence: 99%

“…However, the association between frailty and the prognosis of patients after PCI remains unclear (14). Most studies showed that frailty is independently associated with higher risk of mortality and adverse events after PCI (15)(16)(17)(18)(19)(20)(21)(22), while some did not (23,24). Accordingly, a previous meta-analysis included eight cohort studies and showed that frailty was associated with a higher risk of death for patients after PCI (25).…”

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confidence: 99%

“…Besides, this meta-analysis included studies with univariate analysis and a study using continuous gait speed as the indicator of frailty (28), which made the results of the metaanalysis difficult to interpret. Since several relevant cohort studies (17)(18)(19)(20)(21)(22)24) have been published since the previous meta-analysis, we aimed to perform an updated meta-analysis to summarize the current understanding for the association between frailty and prognosis after PCI.…”

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

Wang

Zhang

et al. 2021

Front. Med.

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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.

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“…However, it emphasized other conditions such as peripheral arterial disease and heart failure, which would make these subjects more likely to be frail, while in an inverse association analysis frailty would not precede the development of CVD 22 . In addition to the above, as it represents a greater risk for longlived old people in events related to AMI, studies suggest the assessment of frailty as a prognostic factor in the treatment of this population 23 .…”

Section: Discussionmentioning

confidence: 99%

Prevalência de fragilidade e fatores associados em idosos pós-acidente vascular cerebral

Vasconcelos

Marques

Leite

et al. 2020

Rev. bras. geriatr. gerontol.

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Resumo Objetivo avaliar a prevalência da fragilidade e fatores associados em idosos acometidos por acidente vascular cerebral (AVC). Método estudo transversal, com pacientes de idade igual ou maior que 60 anos, assistidos em ambulatório de neurologia. A coleta de dados foi realizada por questionário contendo dados sociodemográficos, clínicos, hábitos de vida e assistência na área de reabilitação e pelos instrumentos Mini Exame do Estado Mental e Escala de Fragilidade de Edmonton. Resultados a população do estudo foi composta por 69 pessoas idosas, com média de idade de 72 (±7,4) anos. Entre os frágeis estavam os indivíduos mais longevos (90,9%), do sexo feminino (92,3%), com estado civil que representasse ter tido companheiro em algum momento da vida (separado, divorciado ou viúvo) (94,4%), que não moravam sozinhos (80,3%), sem nenhuma escolaridade (80,6%) e renda (100%), que se declararam da cor negra (100%) e de religião espírita (100%). A maioria não apresentou comorbidades ou hábitos de vida deletérios, a exceção da hipertensão arterial sistêmica. Houve ainda, baixa assistência na área de reabilitação. A avaliação pelo MEEM indicou estado mental alterado para 83,7% dos idosos frágeis. Foram encontradas associações significativas entre a fragilidade e o estado civil (p=0,042), com a presença da diabetes mellitus (p=0,002), e ausência de infarto agudo do miocárdio (p=0,030). Conclusão Sugere-se a realização de estudos que possam acompanhar esse tipo de população acometida pelo AVC, desde a hospitalização até a alta da reabilitação, com vistas a esclarecer o processo de declínio funcional e cognitivo e sua relação com a fragilidade.

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Influence of Preadmission Frailty on Short- and Mid-Term Prognoses in Octogenarians With ST-Elevation Myocardial Infarction

Cited by 29 publications

References 37 publications

The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction

The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction

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

Prevalência de fragilidade e fatores associados em idosos pós-acidente vascular cerebral

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