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The online version of this article (https://doi.org/10.1007/s12471-019-1240-7) contains supplementary material, which is available to authorized users.
Consistent with the aging population in the Western world, there is a growing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy in elderly patients; risk models to determine which of these patients are prone to have poor clinical outcomes are, however, essential. The purpose of this study was to assess the association between frailty and short-term mortality and PCI-related serious adverse events (SAE) in elderly patients.
All STEMI patients (aged ≥70 years) treated with primary PCI in 2013–2015 at the Leiden University Medical Centre were assessed. The Safety Management Programme (VMS) score was used to identify frail elderly patients. The primary endpoint was 30-day all-cause mortality; the secondary endpoint included 30-day clinical death, target vessel failure, major bleeding, contrast induced kidney insufficiency and stroke.
A total of 206 patients were included (79 ± 6.4 years, 119 [58%] male). The VMS score was ≥1 in 28% of all cases. Primary and secondary endpoint rates were 5 and 23% respectively. VMS score ≥1 was an independent predictor for both 30-day mortality (odds ratio [OR] 9.6 [95% confidence interval, CI 1.6–56.9] p-value = 0.013) and 30-day SAE (OR 2.9 [95% CI 1.1–7.9] p-value = 0.038).
VMS score for frailty is independently associated with short-term mortality and PCI-related SAE in elderly patients with STEMI treated with primary PCI. These results suggest that frailty in elderly patients is an important feature to measure and to be taken into account when developing risk models.
Supplemental file 1. Table 1 Baseline characteristics of patients with follow-up versus patients without follow-up for 30-days serious adverse events12471_2019_1240_MOESM1_ESM.docx
Claessen BE, Kikkert WJ, Engstrom AE, et al. Primary percutaneous coronary intervention for ST elevation myocardial infarction in octogenarians: trends and outcomes. Heart. 2010;96:843–7. CrossRef
Centers for Disease Control and Prevention. MMWR series on public health and aging. MMWR Morb Mortal Wkly Rep. 2003;52:101–6.
Arnold SV, Alexander KP, Masoudi FA, et al. The effect of age on functional and mortality outcomes after acute myocardial infarction. J Am Geriatr Soc. 2009;57:209–17. CrossRef
Rich MW. Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol. 2006;15:7–11. CrossRef
Antonsen L, Jensen LO, Terkelsen CJ, et al. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013;81:912–9. CrossRef
DeGeare VS, Stone GW, Grines L, et al. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol. 2000;86:30–4. CrossRef
Feldman DN, Gade CL, Slotwiner AJ, et al. Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry). Am J Cardiol. 2006;98:1334–9. CrossRef
Mehta RH, Rathore SS, Radford MJ, et al. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol. 2001;38:736–41. CrossRef
Kvakkestad KM, Abdelnoor M, Claussen PA, et al. Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: a prospective cohort study. Eur Heart J Acute Cardiovasc Care. 2016;5:243–52. CrossRef
Gharacholou SM, Lopes RD, Alexander KP, et al. Age and outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: findings from the APEX-AMI trial. Arch Intern Med. 2011;171:559–67. CrossRef
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56. CrossRef
Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58:681–7. CrossRef
Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381:752–62. CrossRef
Heim N, van Fenema EM, Weverling-Rijnsburger AW, et al. Optimal screening for increased risk for adverse outcomes in hospitalised older adults. Age Ageing. 2015;44:239–44. CrossRef
Velders MA, James SK, Libungan B, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001 to 2011: a report from the Swedish coronary Angiography and Angioplasty registry (SCAAR) registry. Am Heart J. 2014;167:666–73. CrossRef
Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619. CrossRef
O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:362–425. CrossRef
Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and pxychosocial function. JAMA. 1963;185:914–9. CrossRef
Fox KA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333:1091. CrossRef
Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000;102:2031–7. CrossRef
Terkelsen CJ, Sorensen JT, Maeng M, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010;304:763–71. CrossRef
Ekerstad N, Swahn E, Janzon M, et al. Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation. 2011;124:2397–404. CrossRef
Ekerstad N, Swahn E, Janzon M, et al. Frailty is independently associated with 1‑year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol. 2014;21:1216–24. CrossRef
Alonso Salinas GL, Sanmartin Fernandez M, Pascual Izco M, et al. Frailty is a short-term prognostic marker in acute coronary syndrome of elderly patients. Eur Heart J Acute Cardiovasc Care. 2016;5:434–40. CrossRef
Sujino Y, Tanno J, Nakano S, et al. Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction. J Cardiol. 2015;66:263–8. CrossRef
Singh M, Rihal CS, Lennon RJ, et al. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes. 2011;4:496–502. CrossRef
- Frailty score for elderly patients is associated with short-term clinical outcomes in patients with ST-segment elevated myocardial infarction treated with primary percutaneous coronary intervention
M. P. J. Hermans
D. C. Eindhoven
L. A. M. van Winden
G. J. de Grooth
G. J. Blauw
M. J. Schalij
- Bohn Stafleu van Loghum