Center for Medical Technology Assessment/IMH, Linköping University, Sandbäcksgatan 7, 58183 Linköping, Sweden.
Circulation. 2011 Nov 29;124(22):2397-404. doi: 10.1161/CIRCULATIONAHA.111.025452. Epub 2011 Nov 7.
For the large and growing population of elderly patients with cardiovascular disease, it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiological reserves. We analyzed the manner in which the variable frailty predicts short-term outcomes for elderly non-ST-segment elevation myocardial infarction patients.
Patients aged ≥ 75 years, with diagnosed non-ST-segment elevation myocardial infarction were included at 3 centers, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. The impact of the comorbid conditions on risk was quantified by the coronary artery disease-specific index. Of 307 patients, 149 (48.5%) were considered frail. By multiple logistic regression, frailty was found to be strongly and independently associated with risk for the primary composite outcome (death from any cause, myocardial reinfarction, revascularization due to ischemia, hospitalization for any cause, major bleeding, stroke/transient ischemic attack, and need for dialysis up to 1 month after inclusion) (odds ratio, 2.2; 95% confidence interval, 1.3-3.7), in-hospital mortality (odds ratio, 4.6; 95% confidence interval, 1.3-16.8), and 1-month mortality (odds ratio, 4.7; 95% confidence interval, 1.7-13.0).
Frailty is strongly and independently associated with in-hospital mortality, 1-month mortality, prolonged hospital care, and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept in regard to cardiovascular patients with complex needs.
对于患有心血管疾病的老年患者这一庞大且不断增长的人群，确定具有临床相关性的生物学年龄指标及其对风险的影响非常重要。虚弱是医学领域的一个新兴概念，它表示易损性增加和生理储备减少。我们分析了脆弱性变量预测老年非 ST 段抬高型心肌梗死患者短期结局的方式。
在 3 个中心纳入年龄≥75 岁、诊断为非 ST 段抬高型心肌梗死的患者，并前瞻性收集包括判断虚弱程度在内的临床数据。根据加拿大健康与老龄化研究临床虚弱量表定义虚弱。通过冠状动脉疾病特异性指数来量化合并症对风险的影响。在 307 例患者中，149 例（48.5%）被认为虚弱。通过多因素逻辑回归分析发现，虚弱与主要复合结局（任何原因导致的死亡、心肌再梗死、缺血导致的血运重建、任何原因导致的住院、主要出血、卒中和短暂性脑缺血发作、纳入后 1 个月内需透析）的风险（比值比，2.2；95%置信区间，1.3-3.7）、院内死亡率（比值比，4.6；95%置信区间，1.3-16.8）和 1 个月死亡率（比值比，4.7；95%置信区间，1.7-13.0）之间存在强独立相关性。
虚弱与院内死亡率、1 个月死亡率、延长住院时间和主要复合结局之间存在强独立相关性。虚弱和合并症的联合使用可能构成心血管疾病复杂患者的最终风险预测概念。
