Díez-Villanueva Pablo, Cepas-Guillén Pedro, López Lluva María Thiscal, Jurado-Román Alfonso, Bazal-Chacón Pablo, Negreira-Caamaño Martín, Olavarri-Miguel Iván, Elorriaga Ane, Rivera-López Ricardo, Escribano David, Salinas Pablo, Martínez-Avial María, Martínez-Guisado Antonio, González-Maniega Clea, Díez-Delhoyo Felipe
Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain.
Servicio de Cardiología, Hospital Clinic, Barcelona, Spain.
J Geriatr Cardiol. 2025 Jan 28;22(1):159-168. doi: 10.26599/1671-5411.2025.01.003.
To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome (NSTEACS).
The IMPACT-TIMING-GO registry (IMPACT of Time of Intervention in patients with Myocardial Infarction with Non-ST seGment elevation. ManaGement and Outcomes) prospectively included 1020 patients with NSTEACS undergoing invasive coronary angiography between April and May 2021. For this sub-study, patients ≥ 65 years were selected. Frailty was assessed according to FRAIL scale. We studied all-cause mortality and the composite of all-cause mortality or all-cause hospitalizations at one-year follow-up after discharge.
Five hundred and sixty seven patients (mean age: 75.8 ± 6.7 years, 28.2% women) were included: 316 (55.7%) were robust, 183 (32.3%) prefrail, and 68 (12.0%) frail. Frail patients were significantly older, more often women, and presented a worse baseline clinical profile. There were no differences among groups regarding pretreatment with a P2Y12 inhibitor. An urgent angiography (< 24 h) was less frequently performed in frail patients, with no differences regarding revascularization approach or in main in-hospital adverse events, although acute kidney disease occurred more frequently in frail patients. At 1-year follow-up, 20 patients died (3.6%). Chronic kidney disease was independently associated with 1-year all-cause death, although a trend towards higher mortality was observed in frail patients (HR = 3.01; 95% CI: 0.93-9.78; = 0.065). Frailty was independently associated with higher 1-year all-cause mortality or all-cause rehospitalizations (HR = 2.23; 95% CI: 1.43-3.46; < 0.001).
In older patients with NSTEACS, frailty independently associates higher all-cause mortality or all-cause hospital admissions at one-year follow-up.
评估当代非ST段抬高型急性冠状动脉综合征（NSTEACS）老年患者中衰弱的患病率及其一年预后。
IMPACT-TIMING-GO注册研究（心肌梗死合并非ST段抬高患者干预时间的影响。管理与结局）前瞻性纳入了2021年4月至5月期间接受有创冠状动脉造影的1020例NSTEACS患者。在这项子研究中，选择年龄≥65岁的患者。根据FRAIL量表评估衰弱情况。我们研究了出院后一年随访时的全因死亡率以及全因死亡率或全因住院的复合情况。
纳入了567例患者（平均年龄：75.8±6.7岁，28.2%为女性）：316例（55.7%）为强壮，183例（32.3%）为虚弱前期，68例（12.0%）为虚弱。虚弱患者年龄显著更大，女性更多，且基线临床特征更差。在P2Y12抑制剂预处理方面，各组之间没有差异。虚弱患者较少进行紧急血管造影（<24小时），在血运重建方法或主要院内不良事件方面没有差异，尽管急性肾疾病在虚弱患者中更频繁发生。在1年随访时，20例患者死亡（3.6%）。慢性肾病与1年全因死亡独立相关，尽管在虚弱患者中观察到死亡率有升高趋势（HR=3.01；95%CI：0.93-9.78；P=0.065）。衰弱与1年更高的全因死亡率或全因再住院独立相关（HR=2.23；95%CI：1.43-3.46；P<0.001）。
在老年NSTEACS患者中，衰弱在一年随访时独立与更高的全因死亡率或全因住院相关。
