Invasive strategy and frailty in very elderly patients with acute coronary syndromes

Isaac Llaó, Albert Ariza-Solé, Juan Sanchís, Oriol Alegre, Ramon López-Palop, Francesc Formiga, Francisco Marín, María T. Vidán, Manuel Martínez-Sellés, Alessandro Sionis, Miguel Vives-Borrás, Joan Antoni Gómez-Hospital, Josep Gómez-Lara, Gerard Roura, Pablo Díez-Villanueva, Iván Núñez-Gil, Jaume Maristany, Lluis Asmarats, Héctor Bueno, Emad Abu-AssiÀngel Cequier

    Research output: Contribution to journalArticleResearchpeer-review

    20 Citations (Scopus)

    Abstract

    © Europa Digital & Publishing 2018. Aims: Current guidelines recommend an early invasive strategy in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The aim of this substudy was to assess the impact of an invasive strategy on outcomes according to the degree of frailty in these patients. Methods and results: The LONGEVO-SCA registry included unselected NSTEACS patients aged =80 years. A geriatric assessment, including frailty, was performed during hospitalisation. During the admission, we evaluated the impact of an invasive strategy on the incidence of cardiac death, reinfarction or new revascularisation at six months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had a lower proportion of frailty (23.3% vs. 40.3%, p<0.001). The incidence of cardiac events was more common in patients managed conservatively, after adjusting for confounding factors (sub-hazard ratio [sHR] 2.32, 95% confidence interval [CI]: 1.26-4.29, p=0.007). This association remained significant in non-frail patients (sHR 3.85, 95% CI: 2.13-6.95, p=0.001), but was not significant in patients with established frailty criteria (sHR 1.40, 95% CI: 0.72-2.75, p=0.325). The interaction invasive strategy-frailty was significant (p=0.032). Conclusions: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.
    Original languageEnglish
    Pages (from-to)e336-e342
    JournalEuroIntervention
    Volume14
    Issue number3
    DOIs
    Publication statusPublished - 1 Jun 2018

    Keywords

    • ACS/NSTE-ACS
    • Clinical research
    • Elderly (&gt;75)

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