Coronary angiography and percutaneous coronary intervention in frail patients over 70 years old with acute coronary syndrome referred for invasive treatment Article Swipe

Background Studies have shown that frailty is associated with worse outcome in older patients with acute coronary syndrome (ACS). However, findings related to the coronary angiography (CAG) and outcome related to the level of revascularization status at discharge in these patients, is not well investigated. Purpose We wanted to investigate CAG findings in ACS patients ≥70 years old, related to the level of frailty at admission, and to examine whether 12-month outcome was associated to the level of revascularization status and frailty at the time of discharge. Methods This is a substudy from a prospective study including all patients ≥70 years referred for invasive treatment for ACS from September 2020 to September 2021. Patients were undergoing frailty assessment with the clinical frailty scale (CFS) at the time of arrival to the department. A CFS score of 1-3 were defined as robust, 4 as vulnerable and 5-9 as frail. Primary endpoint was all-cause mortality at 12-month follow-up. Results 455 patients had their level of frailty assessed and were followed for 12 months, 69 (15%) patients were frail, 79 (17%) were vulnerable and 307 (68%) were robust. Frail patients were significantly older (frail: 80.9 (±5.6) years, vulnerable: 78.5 (±5.7) years and robust: 76.7 (±4.8) years, p<0.001), more often women (frail: 46.4%, vulnerable: 37.2%, and robust: 30.1%, p=0.028), and had higher Charlson index score (frail: 4.5 [4.0-5.0], vulnerable: 4.0 [4.0-6.0] and robust: 4.0 [3.0-4.0], p<0.001). Frail patients had more often multivessel disease (frail: 27.5%, vulnerable: 21.8% and robust: 23.5%, p=0.018), but were less often undergoing PCI (frail: 56.5%, vulnerable: 53.2% and robust: 68.6%, p=0.014). In patients undergoing PCI, there were no differences in lesions treated and the number of stents used, although frail and vulnerable patients were more often incomplete revascularized (frail: 48.5%, vulnerable: 44.3% and robust: 30.7%, p=0.016), table 1. In Kaplan Meier analyses, frail patients undergoing revascularization had a lower cumulated incidence of all-cause mortality in 12-month follow up (log-rank p=0.053) compared with frail who were not revascularized, figure 1. There were no differences in mortality according to revascularization status in vulnerable (log-rank p=0.29) or robust patients (log-rank p=0.54). Conclusion In this study of patients ≥70 years old referred for invasive treatment of ACS, frail patients had more severe coronary artery disease, but were less often treated with PCI. However, in frail patients undergoing revascularization, the cumulated all-cause mortality in 12-month follow-up were lower as compared to frail who were not revascularized. These findings may represent a selection bias and need to be further investigated in randomized trials.