Prevalence and impact of frailty in older patients with chronic and acute coronary syndrome referred for coronary angiography.

Abstract

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.