Does frailty have an influence on MINOCA?
Authors: Figueiredo M , Paula S O F I A , Santos M A R I A N , Coelho M A R I A N , Almeida S A M U E L , Lopes A R T U R , Almeida L U R D E S 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Frailty is a condition that is associated with aging, the presence of comorbidities and disability. The occurrence of frailty may aggravate the course of illnesses, including myocardial infarction (MI), with significant higher rates of complications and mortality in frail patients.

Purpose
We aim to build and validate for our population a frailty índex (FI) using the information present in the National Registry of Acute Coronary Syndromes (ACS). This will later be used to characterize the sample and evaluate the impact of frailty in patients with acute myocardial infarction with non-obstructive coronary arteries (MINOCA), in terms of management, complications, in-hospital mortality and 1-year mortality in a real-world scenario.

Methods
Multicenter retrospective study, based on the National Registry of ACS, from 1/10/2010-24/10/2022. Only patients hospitalized with a diagnosis of MINOCA (coronary stenosis &lt;50%) were included. FI was created including 22 variables identified from baseline characteristics (Table 1). The FI was calculated, ranging between 0-1. Patients were then divided into two groups: Group A - non-frail (FI ≤0.25) – and Group B – frail (FI&gt;0.25). Kaplan-Meier test was performed to establish the survival rates, CV readmissions (R) and R for other causes, at one year.

Results
A total of 1358 patients were analyzed, 1195 in group A (88.0%) and 163 in group B (12.0%). Mean age was 63.9±13.9 years and 62.8% of the patients were male in group A, while in group B mean age was 68.0±10.8 and 72.4% were men. Group B had more cardiovascular risk factors, such as hypertension (94.5% vs 63.2% p&lt;0.001), diabetes (55.2% vs 22.6% p&lt;0.001), dyslipidemia (52.2% vs 89.0% p&lt;0.001). Patients in group B also had more previous history of heart failure (27.6% vs 4.9% p&lt;0.001), stroke (15.3% vs 3.9% p&lt;0.001) and chronic kidney disease (17.8% vs 1.5% p&lt;0.001). On admission, group B presented: higher heart rate (HR) (15.7% with HR ≥100bpm vs 9.0%; p=0.008), more atrial fibrillation (14.7% vs 6.7%, p&lt;0.001); lower blood pressure (BP) (5.1% with BP &lt;90mmHg vs 1.0%; p&lt;0.001), and higher Killip-Kimball (KK) classification (24.1% in KK class &gt;I vs 8.3%; p&lt;0.001). During hospitalization, group B presented higher maximum creatinine values (2.0±2.2mg/dL vs 1.2±0.9 mg/2mg/dL, p&lt;0.001) and lower hemoglobin values (11.9±2.2 vs 12.9±1.7g/dL, p&lt;0.001). There were no differences between the two groups in terms of complications during hospitalization, intrahospital mortality or regarding lenght of hospital stay or mortality rates, R for CV causes and R for other causes at one-year follow-up, with a Kaplan-Meier test of p=0.186 (Figure 1A), p=0.789 (Figure 1B) and p=0.118 (Figure 1C), respectively.

Conclusions
As expected, frail patients have more comorbidities than non-frail patients. However, this does not translate into differences in terms of patients’ treatment, number of complications, intrahospital mortality, or 1-year follow up. Figures 1A, 1B and 1C