Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Can J Cardiol. 2019 Apr;35(4):430-437. doi: 10.1016/j.cjca.2018.12.035. Epub 2018 Dec 31.
The effect of sex on self-reported frailty in acute coronary syndromes (ACS) is unclear. We examined the prevalence of self-reported frailty and its association with all-cause death among men and women.
Elderly (≥ 65 years) male (n = 2691) and female (n = 2305) patients with ACS enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial were screened using the Fried Frailty Index. Sex differences in prevalence of frailty symptoms and categories (not frail; prefrail [1 to 2 symptoms]; and frail [≥ 3 symptoms]) and their prognostic importance were examined.
Women were older and had higher rates of comorbidities than men. A total of 739 (27.5%) men and 645 (28%) women reported ≥ 1 frailty symptom. Prevalence of frailty increased with age among men but not women. During a median follow-up of 17.3 months, 353 (13.1%) men and 266 (11.5%) women died. After adjusting for age, prefrail men had a 35% increased risk (hazard ratio [HR] 1.35; 95% confidence interval [CI], 1.07-1.71), and frail men had an 80% increased risk (HR 1.80; 95% CI, 1.22-2.67) of death relative to not-frail men. The age-adjusted HR for death in prefrail women was 1.40 (95% CI, 1.07-1.84), and 1.55 (95% CI, 0.96-2.49) in frail women relative to not-frail women. Self-reported slow walk time and decreased physical activity appeared to provide the most prognostic information.
Self-reported frailty was similar among men and women with ACS. Frailty increased with age only among men, in whom it added more prognostic information. Patient-reported frailty may identify elderly patients with ACS, particularly men, at high-risk of mortality.
性别的影响对急性冠状动脉综合征（ACS）患者的自我报告虚弱程度并不明确。我们检测了男女患者中自我报告虚弱的患病率及其与全因死亡率的相关性。
入选参与靶向血小板抑制以明确急性冠状动脉综合征最佳药物治疗策略（TRILOGY ACS）试验的≥ 65 岁的老年男性（n=2691）和女性（n=2305）患者，使用 Fried 虚弱指数进行筛选。分析衰弱症状的流行率及其类别（无虚弱；虚弱前期[1-2 个症状]；虚弱[≥3 个症状]）在性别上的差异，以及它们的预后意义。
女性患者年龄更大且合并症发生率更高。共有 739 例（27.5%）男性和 645 例（28%）女性报告≥1 个虚弱症状。男性患者的虚弱患病率随年龄增长而增加，但女性患者无此趋势。在中位随访 17.3 个月期间，353 例（13.1%）男性和 266 例（11.5%）女性死亡。在调整年龄后，虚弱前期男性的死亡风险增加了 35%（危险比[HR]1.35；95%置信区间[CI]，1.07-1.71），虚弱男性的死亡风险增加了 80%（HR 1.80；95% CI，1.22-2.67），与非虚弱男性相比。虚弱前期女性的死亡风险调整后 HR 为 1.40（95% CI，1.07-1.84），而虚弱女性的 HR 为 1.55（95% CI，0.96-2.49），与非虚弱女性相比。自我报告的慢走时间和体力活动减少似乎提供了最具预后意义的信息。
ACS 患者中，自我报告的虚弱程度在男性和女性之间相似。虚弱仅在男性中随年龄增加而增加，在男性中虚弱增加了更多的预后信息。患者报告的虚弱可能会识别出 ACS 老年患者，尤其是男性，他们具有更高的死亡率风险。
