Background Frailty has been suggested as a valuable marker for predicting outcomes in older patients with cardiovascular disease. However, whether the association between frailty and adverse outcomes is similar in patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) remains unclear. Methods Patients ≥70 years old referred for coronary angiography (CAG) due to CCS or ACS were included and followed for 12 months. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were grouped according to their CFS into frail/vulnerable (CFS≥4) and robust (CFS=1-3). Study endpoints included all-cause mortality and new hospital admissions for bleeding, myocardial infarction, unplanned revascularisation or stroke. Results 678 patients aged ≥70 years with available CFS underwent CAG due to CCS (n=223) or ACS (n=455) and completed 12-month follow-up. The prevalence of frailty/vulnerability was higher in patients referred with CCS compared to those with ACS (CCS:43.0% vs. ACS:32.2%, p=0.009). Frail/vulnerable patients referred with CCS were younger (CCS: 76.6(±4.7) years vs. ACS: 79.6(±5.7) years, p<0.001) and less frequently treated with percutaneous coronary intervention (CCS:40.6% vs. ACS:54.6%, p=0.043). Cumulative all-cause mortality was higher in frail/vulnerable patients referred with ACS but not in those referred with CCS, compared to robust patients (log-rank p<0.001). Conclusion Among patients ≥70 years old referred for CAG 30-40% are frail/vulnerable. Frailty/vulnerability was associated with higher all-cause mortality in patients referred for CAG due to ACS, but not in those referred due to CCS. This difference in outcome may reflect variations in clinical presentation as well as potential referral bias.
H. Ratcovich, F. Joshi, P. Palm et al.· The Cardiology· 0 citations
In the SENIOR-RITA trial, among older adults with non-ST-elevation myocardial infarction (NSTEMI), an invasive strategy did not reduce the composite outcome of cardiovascular death or non-fatal myocardial infarction compared with a conservative strategy over a median follow-up of 4.1 years.
To describe the angiographic characteristics of patients randomized to the invasive arm.
SENIOR-RITA was a prospective, multicentre, randomized controlled trial recruiting NSTEMI patients aged ≥75 years. From November 2016 to March 2023, 1518 patients from 48 UK sites were randomized 1:1 to an invasive or conservative strategy. Procedural data were collected, and angiographic data were analysed using quantitative coronary angiography (QCA) at Newcastle University angiographic core laboratory using QAngio® XA Medis.
Of 680 patients undergoing angiography, QCA analysis was performed in 667 participants. Obstructive coronary artery disease was found in 76.8%, and 13% had prior coronary surgical revascularization. A total of 1173 lesions were identified. Most lesions (29.5%) were classified as type B2 according to the ACC/AHA classification. Lesions in patients not receiving percutaneous coronary intervention (PCI) were angiographically more complex than those treated with PCI, with higher prevalence of type C lesions, bifurcation, ostial lesions, and presence of collaterals. Overall, 330 patients (49.5%) underwent PCI, which was successful in 96.5% with minimal complications.
The SENIOR-RITA angiography sub-study is the largest subgroup analysis to date in older NSTEMI adults providing important insights into the angiographic characteristics and emphasising the importance of a holistic patient-centred care for older adults.
G. Pompei, F. Rubino, Kenny Jenkins et al.· European Heart Journal Open· 0 citations
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