Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Hospital Universitario San Juan, Alicante, Spain.
J Am Med Dir Assoc. 2018 Apr;19(4):296-303. doi: 10.1016/j.jamda.2017.10.007. Epub 2017 Nov 17.
Information about the impact of frailty in patients with acute coronary syndromes (ACS) is scarce. No study has assessed the prognostic impact of frailty as measured by the FRAIL scale in very elderly patients with ACS.
The prospective multicenter LONGEVO-SCA registry included unselected patients with ACS aged 80 years or older. A comprehensive geriatric assessment was performed during hospitalization, including frailty assessment by the FRAIL scale. The primary endpoint was mortality at 6 months.
A total of 532 patients were included. Mean age was 84.3 years, 61.7% male. Most patients had positive troponin levels (84%) and high GRACE risk score values (mean 165). A total of 205 patients were classified as prefrail (38.5%) and 145 as frail (27.3%). Frail and prefrail patients had a higher prevalence of comorbidities, lower left ventricle ejection fraction, and higher mean GRACE score value. A total of 63 patients (11.8%) were dead at 6 months. Both prefrailty and frailty were associated with higher 6-month mortality rates (P < .001). After adjusting for potential confounders, this association remained significant (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.09-6.73 for prefrailty and HR 2.99; 95% CI 1.20-7.44 for frailty, P = .024). The other independent predictors of mortality were age, Charlson Index, and GRACE risk score.
The FRAIL scale is a simple tool that independently predicts mortality in unselected very elderly patients with ACS. The presence of prefrailty criteria also should be taken into account when performing risk stratification of these patients.
关于急性冠状动脉综合征（ACS）患者衰弱的影响信息很少。尚无研究评估 FRAIL 量表评估的衰弱对非常高龄 ACS 患者的预后影响。
前瞻性多中心 LONGEVO-SCA 登记研究纳入了 80 岁或以上的 ACS 未选择患者。住院期间进行了全面的老年评估，包括使用 FRAIL 量表评估衰弱。主要终点是 6 个月时的死亡率。
共纳入 532 例患者。平均年龄为 84.3 岁，61.7%为男性。大多数患者的肌钙蛋白水平升高（84%）和 GRACE 风险评分值较高（平均 165）。205 例患者被归类为虚弱前期（38.5%），145 例患者为虚弱（27.3%）。虚弱和虚弱前期患者的合并症患病率更高，左心室射血分数更低，GRACE 评分平均值更高。共有 63 例患者（11.8%）在 6 个月时死亡。虚弱前期和虚弱均与较高的 6 个月死亡率相关（P<0.001）。在调整潜在混杂因素后，这种相关性仍然显著（虚弱前期的危险比 [HR] 2.71；95%置信区间 [CI] 1.09-6.73；虚弱的 HR 2.99；95% CI 1.20-7.44，P=0.024）。死亡的其他独立预测因素为年龄、Charlson 指数和 GRACE 风险评分。
FRAIL 量表是一种简单的工具，可独立预测未选择的非常高龄 ACS 患者的死亡率。在对这些患者进行风险分层时，还应考虑虚弱前期标准的存在。
