Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.
Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy.
J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1113-1119. doi: 10.1093/gerona/glz123.
The number of older adults admitted to hospital for acute coronary syndrome (ACS) has increased worldwide. The aim of this study was to determine which scale of frailty or physical performance provides incremental improvements in risk stratification of older adults after ACS.
A prospective cohort of 402 older (≥70 years) ACS patients were enrolled. Data about baseline characteristics, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) risk scores were collected. Before hospital discharge, seven scales of frailty and physical performance were measured. The 1-year occurrence of adverse events (cardiac death, reinfarction, and cerebrovascular accident [MACCE] and all-cause mortality) was recorded.
Out of the 402 patients, 43 (10.5%) had a MACCE and 35 (8.7%) died. Following adjustment for confounding factors, scales of frailty and physical performance were associated with adverse events. Among the scales, the addition of short physical performance battery (SPPB) produced the highest incremental value over the initial model generated by baseline characteristics both for MACCE (ΔC-statistic 0.043, p = .04; integrated discrimination improvement (IDI) 0.054, p = .001; net reclassification improvement (NRI) 0.752, p < .001) and all-cause mortality (ΔC-statistic 0.063, p = .02; IDI 0.061, p < .001; NRI 1.022, p < .001). The addition of SPPB scale on top of GRACE or TIMI risk scores led to a considerable improvement in the prediction of MACCE and all-cause mortality (about 15% and 20%, respectively).
The assessment of the physical performance with SPPB scale before hospital discharge increases the ability to predict adverse events in older ACS patients and may be useful in the clinical decision-making process.
www.clinicaltrials.gov NCT02386124.
全球因急性冠状动脉综合征（ACS）住院的老年患者人数有所增加。本研究旨在确定哪种虚弱或身体表现量表可在 ACS 后对老年患者进行风险分层提供额外的改善。
前瞻性纳入 402 例老年（≥70 岁）ACS 患者。收集基线特征、全球急性冠状动脉事件注册（GRACE）和血栓溶解治疗心肌梗死（TIMI）风险评分的数据。在出院前，测量了 7 种虚弱和身体表现量表。记录了 1 年内发生的不良事件（心脏死亡、再梗死和脑血管意外 [MACCE]和全因死亡率）。
402 例患者中，43 例（10.5%）发生 MACCE，35 例（8.7%）死亡。在调整混杂因素后，虚弱和身体表现量表与不良事件相关。在这些量表中，短体适能表现测试（SPPB）的加入比基线特征产生的初始模型对 MACCE（增量 C 统计量 0.043，p =.04；综合判别改善（IDI）0.054，p =.001；净重新分类改善（NRI）0.752，p <.001）和全因死亡率（增量 C 统计量 0.063，p =.02；IDI 0.061，p <.001；NRI 1.022，p <.001）的增量价值最高。在 GRACE 或 TIMI 风险评分的基础上增加 SPPB 量表可显著改善 MACCE 和全因死亡率的预测（分别约为 15%和 20%）。
在出院前使用 SPPB 量表评估身体表现可提高对老年 ACS 患者不良事件的预测能力，并且可能有助于临床决策过程。
www.clinicaltrials.gov NCT02386124。
