Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany.
Cardiovasc Revasc Med. 2020 Jul;21(7):811-818. doi: 10.1016/j.carrev.2019.11.009. Epub 2019 Nov 15.
There is growing awareness that frailty may be an important marker of adverse outcomes in PCI but there is no literature from national cohorts. This study examines a national cohort of patients who underwent percutaneous coronary intervention (PCI) regarding the prevalence of frailty, changes over time, and associated outcomes. The National Inpatients Sample was used to identify adults who underwent PCI procedures between 2004 and 2014. Frailty risk was measured using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5-15 and >15 for low, intermediate and high HFRS. From 7,306,007 admissions, a total of 94.58% of admissions were for patients who had a low HFRS(<5), 5.39% had an intermediate HFRS(5-15) and 0.03% had a high HFRS(>15). The prevalence of intermediate or high frailty risk patients has increased over time from 1.9% in 2004 to 11.7% in 2014. The incidence of in-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS. Mean length of stay also increased from 2.9 days to 17.1 days from low to high HFRS. High frailty risk was independently associated with an OR 9.91 95%CI 7.17-13.71 for in-hospital death, OR 4.99 95%CI 3.82-6.51 for bleeding and OR 3.96 95%CI 3.00-5.23 for vascular injury as compared to patients with low risk of HFRS. While rare in frequency overall, frailty is increasing in prevalence in recent years and intermediate and high HFRS associated with increased odds of mortality compared to low risk of frailty.
人们越来越意识到，衰弱可能是 PCI 不良结局的一个重要标志物，但目前还没有来自全国队列的文献。本研究调查了接受经皮冠状动脉介入治疗 (PCI) 的全国性患者队列，以评估衰弱的流行率、随时间的变化以及相关结局。使用国家住院患者样本 (National Inpatients Sample) 来识别 2004 年至 2014 年间接受 PCI 手术的成年人。使用经过验证的医院衰弱风险评分 (Hospital Frailty Risk Score, HFRS) 来衡量衰弱风险，该评分使用 <5、5-15 和 >15 的切点来区分低、中和高 HFRS。在 7306007 例入院患者中，低 HFRS(<5)患者占 94.58%，中 HFRS(5-15)患者占 5.39%，高 HFRS(>15)患者占 0.03%。从中 HFRS 和高 HFRS 患者的比例来看，衰弱风险较高的患者比例呈上升趋势，从 2004 年的 1.9%增加到 2014 年的 11.7%。低 HFRS 患者的院内死亡率为 1.0%，高 HFRS 患者的院内死亡率为 13.9%。低 HFRS 患者的平均住院时间为 2.9 天，高 HFRS 患者的平均住院时间为 17.1 天。与低 HFRS 患者相比，高 HFRS 患者的院内死亡风险比为 9.91(95%CI：7.17-13.71)，出血风险比为 4.99(95%CI：3.82-6.51)，血管损伤风险比为 3.96(95%CI：3.00-5.23)。虽然总体发生率较低，但近年来衰弱的患病率呈上升趋势，中 HFRS 和高 HFRS 与衰弱低风险患者相比，死亡风险增加。
