年龄≥75岁的非ST段抬高型急性冠状动脉综合征且接受侵入性治疗的虚弱患者的五年临床结局。
Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management.
作者信息
Ratcovich Hanna, Beska Benjamin, Mills Greg, Holmvang Lene, Adams-Hall Jennifer, Stevenson Hannah, Veerasamy Murugapathy, Wilkinson Chris, Kunadian Vijay
机构信息
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
Eur Heart J Open. 2022 May 16;2(3):oeac035. doi: 10.1093/ehjopen/oeac035. eCollection 2022 May.
AIM
Frailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown.
METHODS AND RESULTS
The multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23-4.02, = 0.008; Fried: HR 1.81, 95% CI 1.00-3.27, = 0.048].
CONCLUSION
In older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years.
REGISTRATION
Clinicaltrials.gov NCT01933581.
目的
衰弱与老年急性冠状动脉综合征（ACS）患者的不良结局相关。衰弱对非ST段抬高型ACS（NSTEACS）进行侵入性治疗后的长期临床结局的影响尚不清楚。
方法与结果
多中心高危ACS患者改善临床结局研究1（ICON-1）前瞻性队列研究纳入了年龄>75岁、NSTEACS后接受冠状动脉造影的患者。根据加拿大健康与老龄化临床衰弱量表（CFS）和弗里德标准评估的衰弱情况对患者进行分类。主要复合终点为全因死亡率、非计划血管重建、心肌梗死、中风和出血。在263例患者中，根据CFS，33例（12.5%）为衰弱，152例（57.8%）为衰弱前期，78例（29.7%）为强健。根据弗里德标准，70例患者（26.6%，平均年龄82.1岁）为衰弱，147例（55.9%，平均年龄81.3岁）为衰弱前期，46例（17.5%，平均年龄79.9岁）为强健。根据CFS，衰弱患者在5年时复合终点更为常见（衰弱：22例，66.7%；衰弱前期：81例，53.3%；强健：27例，34.6%，P = 0.003），使用弗里德标准时也有类似趋势（衰弱：39例，55.7%；衰弱前期：72例，49.0%；强健：16例，34.8%，P = 0.085）。用CFS和弗里德标准测量的衰弱均与主要终点相关[与强健组相比，年龄和性别调整后的风险比（HR）。CFS：2.22，95%置信区间（CI）1.23 - 4.02，P = 0.008；弗里德：HR 1.81，95%CI
Zotero 插件