Alonso Salinas Gonzalo Luis, Sanmartín Fernández Marcelo, Pascual Izco Marina, Marco Del Castillo Álvaro, Rincón Díaz Luis Miguel, Lozano Granero Cristina, Valverde Gómez María, Pastor Pueyo Pablo, Del Val Martín David, Pardo Sanz Ana, Monteagudo Ruiz Juan Manuel, Recio-Mayoral Alejandro, Salvador Ramos Luis, Marzal Martín Domingo, Camino López Asunción, Jiménez Mena Manuel, Zamorano Gómez José Luis
Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
Department of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Colmenar Viejo Road km 9.100, 28034, Madrid, Spain.
Int J Cardiol. 2016 Nov 1;222:590-593. doi: 10.1016/j.ijcard.2016.07.268. Epub 2016 Aug 1.
Bleeding in ACS patients is an independent marker of adverse outcomes. Its prognostic impact is even worse in elderly population. Current bleeding risk scores include chronological age but do not consider biologic vulnerability. No studies have assessed the effect of frailty on major bleeding. The aim of this study is to determine whether frailty status increases bleeding risk in patients with ACS.
This prospective and observational study included patients aged ≥75years admitted due to type 1 myocardial infarction. Exclusion criteria were severe cognitive impairment, impossibility to measure handgrip strength, cardiogenic shock and limited life expectancy due to oncologic diseases. The primary endpoint was 30-day major bleeding defined as a decrease of ≥3g/dl of haemoglobin or need of transfusion.
A total of 190 patients were included. Frail patients (72, 37.9%) were older, with higher comorbidity features and with a higher CRUSADE score at admission. On univariate analysis, frailty predicted major bleeding during 30-day follow-up despite less frequent use of a P2Y12 inhibitor (66.2% vs 83.6%, p=0.007) and decreased catheterisation rate (69.4% vs 94.1%, p<0.001). Major bleeding was associated with increased all-cause mortality at day 30 (18.2% vs 2.5%, p<0.001). On multivariate analysis, frailty was an independent predictor for major bleeding.
Frailty phenotype, as a marker of biological vulnerability, is an independent predictor of major bleeding in elderly patients with ACS. Frailty can play an important role in bleeding risk stratification and objective indices should be integrated into routine initial evaluation of these patients.
急性冠状动脉综合征（ACS）患者出血是不良预后的独立标志物。其对老年人群的预后影响更差。目前的出血风险评分纳入了实际年龄，但未考虑生物学易损性。尚无研究评估衰弱对大出血的影响。本研究旨在确定衰弱状态是否会增加ACS患者的出血风险。
这项前瞻性观察性研究纳入了因1型心肌梗死入院的≥75岁患者。排除标准为严重认知障碍、无法测量握力、心源性休克以及因肿瘤疾病导致预期寿命有限。主要终点为30天大出血，定义为血红蛋白下降≥3g/dl或需要输血。
共纳入190例患者。衰弱患者（72例，37.9%）年龄更大，合并症更多，入院时CRUSADE评分更高。单因素分析显示，尽管使用P2Y12抑制剂的频率较低（66.2%对83.6%，p = 0.007）且导管插入率较低（69.4%对94.1%，p<0.001），但衰弱仍可预测30天随访期间的大出血。大出血与30天时全因死亡率增加相关（18.2%对2.5%，p<0.001）。多因素分析显示，衰弱是大出血的独立预测因素。
衰弱表型作为生物学易损性的标志物，是老年ACS患者大出血的独立预测因素。衰弱在出血风险分层中可发挥重要作用，客观指标应纳入这些患者的常规初始评估中。
