Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Spain.
Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
Eur J Clin Invest. 2021 May;51(5):e13505. doi: 10.1111/eci.13505. Epub 2021 Feb 12.
There is scarce information on the prognostic role of frailty and atrial fibrillation (AF) in elderly patients with acute coronary syndrome (ACS).
The aim was to analyse the management of elderly patients with frailty and AF who suffered an ACS using data of the prospective multicentre LONGEVO-SCA registry. We evaluated the predictive performance of FRAIL, Charlson scores and AF status for adverse events at 6-month follow-up.
A total of 531 unselected patients with ACS and above 80 years old [mean age 84.4 (SD = 3.6) years; 322 (60.6%) male] were enrolled, of whom 128 (24.1%) with AF and 145 (27.3%) with frailty. Mutually exclusive number of patients were as follows: non-frail and sinus rhythm (SR) 304 (57.2%); frail and SR 99 (18.6%); non-frail and AF 82 (15.4%); and frail and AF 46 (8.7%). Frail and AF patients compared with non-frail and SR patients had higher risk of all-cause mortality [HR 2.61, (95% CI 1.28-5.31; P = .008)], readmissions [HR 2.28, (95%CI 1.37-3.80); P = .002)] and its composite [HR 2.28, (95% CI 1.44-3.60); P < .001)]. After multivariate adjustment, FRAIL score [HR 1.41, (95% CI 1.02-1.97); P = .040] and Charlson index [HR 1.32, (95% CI 1.09-1.59); P = .003] were significantly associated with mortality. AF status was not independently related with adverse events.
Frailty but not AF status was independently associated with follow-up adverse events. Frailty status and high Charlson index were independent conditions associated with adverse events during the follow-up. The impact of functional status has a bigger prognostic role over AF status in elderly patients with ACS.
关于衰弱和心房颤动（AF）在老年急性冠状动脉综合征（ACS）患者中的预后作用，相关信息十分匮乏。
本研究旨在使用前瞻性多中心 LONGEVO-SCA 登记处的数据，分析患有 ACS 的衰弱和 AF 的老年患者的管理情况。我们评估了 FRAIL、Charlson 评分和 AF 状态在 6 个月随访时对不良事件的预测性能。
共纳入 531 名年龄在 80 岁以上的未选择 ACS 患者[平均年龄 84.4（SD=3.6）岁；322 名（60.6%）为男性]，其中 128 名（24.1%）患有 AF，145 名（27.3%）患有衰弱。互斥的患者数量如下：非衰弱和窦性节律（SR）304 名（57.2%）；衰弱和 SR 99 名（18.6%）；非衰弱和 AF 82 名（15.4%）；衰弱和 AF 46 名（8.7%）。与非衰弱和 SR 患者相比，衰弱和 AF 患者的全因死亡率[HR 2.61，（95%CI 1.28-5.31；P=0.008）]、再入院率[HR 2.28，（95%CI 1.37-3.80；P=0.002）]及其复合终点[HR 2.28，（95%CI 1.44-3.60；P<0.001）]更高。多变量调整后，FRAIL 评分[HR 1.41，（95%CI 1.02-1.97）；P=0.040]和 Charlson 指数[HR 1.32，（95%CI 1.09-1.59）；P=0.003]与死亡率显著相关。AF 状态与不良事件无独立相关性。
衰弱而非 AF 状态与随访不良事件独立相关。衰弱状态和高 Charlson 指数是与 ACS 老年患者随访期间不良事件相关的独立因素。在老年 ACS 患者中，功能状态的预后作用大于 AF 状态。
