Frailty predicts major bleeding within 30 days in elderly patients with Acute Coronary Syndrome

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• 作者：Gonzalo Luis Alonso Salinas ; M.D.^a ; ^{Gonzalol.alonso@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Marcelo Sanmartí ; n Ferná ; ndez ; Ph.D. M.D.^a ; Marina Pascual Izco ; M.D.^a ; Á ; lvaro Marco del Castillo ; M.D.^a ; Luis Miguel Rincó ; n Dí ; az ; M.D.^a ; Cristina Lozano Granero ; M.D.^a ; Marí ; a Valverde Gó ; mez ; M.D.^a ; Pablo Pastor Pueyo ; M.D.^a ; David del Val Martí ; n ; M.D.^a ; Ana Pardo Sanz ; M.D.^a ; Juan Manuel Monteagudo Ruiz ; M.D.^a ; Alejandro Recio-Mayoral ; M.D.^b ; Luis Salvador Ramos ; M.D.^c ; Domingo Marzal Martí ; n ; M.D.^c ; Asunció ; n Camino Ló ; pez ; M.D.^a ; Manuel Jimé ; nez Mena ; M.D.^a ; José ; Luis Zamorano Gó ; mez ; Ph.D. M.D.^a
• 关键词：ACE Inhibitor ; angiotensin-converting-enzyme inhibitor ; ACS ; Acute Coronary Syndrome ; ARB ; Angiotensin II Receptor Blocker ; ASA ; acetylsalicylic acid ; BNP ; brain natriuretic peptide ; CABG ; coronary artery bypass grafting ; CCB ; calcium channel blocker ; CI ; confidence interval ; CRP ; C-reactive protein ; DAPT ; dual antiplatelet therapy ; DM ; diabetes mellitus ; Katz ADL ; Katz Index of Independence in Activities of Daily Living ; LVEF ; left ventricular ejection fraction ; MI ; myocardial infarction ; MR ; m
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：590-593
• 全文大小：213 K

文摘

Bleeding in ACS patients is an independent marker of adverse outcomes. Its prognostic impact is even worse in elderly population. Current bleeding risk scores include chronological age but do not consider biologic vulnerability. No studies have assessed the effect of frailty on major bleeding. The aim of this study is to determine whether frailty status increases bleeding risk in patients with ACS.

Methods

This prospective and observational study included patients aged ≥ 75 years admitted due to type 1 myocardial infarction. Exclusion criteria were severe cognitive impairment, impossibility to measure handgrip strength, cardiogenic shock and limited life expectancy due to oncologic diseases. The primary endpoint was 30-day major bleeding defined as a decrease of ≥ 3 g/dl of haemoglobin or need of transfusion.

Results

A total of 190 patients were included. Frail patients (72, 37.9%) were older, with higher comorbidity features and with a higher CRUSADE score at admission. On univariate analysis, frailty predicted major bleeding during 30-day follow-up despite less frequent use of a P2Y12 inhibitor (66.2% vs 83.6%, p = 0.007) and decreased catheterisation rate (69.4% vs 94.1%, p < 0.001). Major bleeding was associated with increased all-cause mortality at day 30 (18.2% vs 2.5%, p < 0.001). On multivariate analysis, frailty was an independent predictor for major bleeding.

Conclusion

Frailty phenotype, as a marker of biological vulnerability, is an independent predictor of major bleeding in elderly patients with ACS. Frailty can play an important role in bleeding risk stratification and objective indices should be integrated into routine initial evaluation of these patients.