Prevalence and impact of frailty in elderly patients with chronic and acute coronary syndrome referred for coronary angiography
Authors: Ratcovich H , Joshi F , Palm P , Faerch J , Bang L , Tilsted H , Sadjadieh G , Engstom T , Holmvang L 
Published: November 2023

Abstract

Background
The population is getting older worldwide, therefore specific knowledge regarding elderly with cardiovascular disease (CVD) is increasingly needed. Frailty has previously been suggested as a valuable marker for outcome prediction in older CVD patients. Whether the importance of frailty is similar in patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) is not well described.

Purpose
To compare outcome among frail patients ≥70 years old refereed for coronary angiography (CAG) due to CCS and ACS.

Methods
Patients ≥70 years old, referred for CAG due to CCS or ACS at our department between 2020-2021, were included in the study and followed for one year. Frailty was evaluated with the Clinical Frailty Scale (CFS) by trained nurses as a part of everyday practice at the cardiology ward. Patients were pooled according to their CFS into a frail/vulnerable (CFS ≥4) and a robust group (CFS 1-3). Study endpoints were all-cause mortality and new hospital admissions for bleeding, myocardial infarction (MI), unplanned revascularisation, or stroke.

Results
During the study period, a total of 678 patients ≥70 years underwent CAG due to CCS (n=223) or ACS (n=455), had their level of frailty evaluated and completed one-year follow-up. The prevalence of frailty/vulnerability was higher among patients with CCS as compared to patients with ACS (CCS: 43.0% vs. ACS: 32.2%, p=0.009).
Frail/vulnerable patients with CCS were younger (CCS: 76.6 (4.7) years vs. ACS: 79.6 (5.7) years, p&lt;0.001), and had a higher body mass index (CCS: 28.5 (4.6) kg/m2 vs. ACS: 27.1 (5.1) kg/m2). Furthermore, frail/vulnerable patients with CCS had more often a history of coronary artery disease, heart failure and hypercholesteremia. PCI was more frequently performed in frail/vulnerable patients with ACS compared to CCS (CCS 40.6% vs. ACS 54.6%, p=0.043) and the use of coronary artery bypass was very low (CCS 6.2% vs. ACS 4.1%, p=0.637), table 1.
At one-year follow-up, all-cause mortality was lower among frail/vulnerable patients with CCS (CCS: 4.2% vs. ACS: 23.1%, p&lt;0.001). There was no difference in the number of new hospital admissions for bleeding, MI, unplanned revascularisation, or stroke (CCS: 39.4% vs ACS: 42.0%, p=0.79). In Kaplan Meier analysis, cumulated all-cause mortality was lower among both frail/vulnerable and robust patients with CCS as well as robust patients with ACS, as compared to frail/vulnerable patients with ACS (log-rank p&lt;0.001), figure 1. There was no difference in all-cause mortality among robust patients with CCS, as compared to robust patients with ACS (Hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.11-1.27, p=0.11).

Conclusion
Among patients ≥70 years old referred for CAG, frailty was associated with a higher all-cause mortality in patients with ACS, but not in patients with CCS. Furthermore, there were no differences in one-year all-cause mortality between robust patients with CCS and ACS.Table 1Figure 1