Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
J Am Med Dir Assoc. 2017 Dec 1;18(12):1097.e1-1097.e10. doi: 10.1016/j.jamda.2017.09.002. Epub 2017 Nov 1.
Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting.
PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI.
A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I: 79%). Subgroup analysis using the Fried score reduced I to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001).
Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.
衰弱已被确定为死亡的一个风险因素。然而，衰弱是否会增加接受经皮冠状动脉介入治疗（PCI）患者的死亡风险仍存在争议。因此，我们对该领域的衰弱评估工具与死亡率结局的相关研究进行了系统回顾和荟萃分析。
检索 PubMed 和 EMBASE 数据库，查找截至 2017 年 7 月 23 日评估 PCI 后个体的衰弱评估工具与死亡率之间关联的研究。
从我们的检索策略中总共获得 141 项研究。最终的荟萃分析共纳入 8 项研究，涉及 2332 例患者（平均年龄：69 岁；68%为男性，随访时间为 30 ± 28 个月）。衰弱是 PCI 后全因死亡率的一个显著预测因素，其风险比（HR）为 2.97（95%置信区间[CI]：1.56-5.66，P =.001）。存在明显的异质性（I：79%）。使用 Fried 评分进行的亚组分析将 I 降低至 68%，但并未改变合并的 HR（2.78，95%CI 1.02-7.76；P <.05）。使用加拿大健康老龄化研究临床衰弱量表将 I 降低至 0%，同时保留合并的 HR（5.99，95%CI 2.77-12.95，P <.001）。
衰弱会导致接受 PCI 的患者死亡率显著增加。Fried 评分和加拿大健康老龄化研究临床衰弱量表都是死亡率的有力预测因素。这些发现可能支持这样一种观点，即对于需要血运重建的虚弱患者，应该考虑采用一种替代侵入性策略。
