Brief report
Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome

https://doi.org/10.1016/j.mayocp.2017.01.018Get rights and content

Abstract

The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome.

Section snippets

Patients and Methods

This was a prospective cohort design including 342 consecutive patients (from October 1, 2010, to February 1, 2012), survivors of acute coronary syndrome, from the Cardiology Department of the University Clinic Hospital in Valencia, Spain. A detailed description of the study design has been explained elsewhere.4 In brief, inclusion criteria were admission for acute coronary syndrome (either ST-segment elevation or non–ST-segment elevation acute coronary syndrome), older than 65 years, and

Baseline Characteristics

The baseline characteristics of the patients are presented in Supplemental Table 1. The mean age was 77.5±7.1 years. Seventy-two patients (21%) had ST-segment elevation acute myocardial infarction; 25 of them (35%) were treated with primary coronary angioplasty, whereas 24 (33%) received fibrinolytic treatment. On the other hand, 213 of 270 patients with non–ST-segment elevation acute coronary syndrome (80%) underwent a coronary angiogram during hospitalization. The median length of stay was 6

Discussion

The present study analyzed the long-term prognostic value of geriatric conditions beyond age after acute coronary syndrome. The main finding was that frailty and comorbidity provided significant incremental prognostic information and reclassified the risk of all-cause mortality beyond what age alone can do. Therefore, risk stratification after acute coronary syndrome needs to consider not only age but also frailty and comorbidity.

Age is a well-known predictive factor for all-cause mortality

Conclusion

Frailty and comorbidity are more important mortality predictors than is age after acute coronary syndrome. Indeed, they significantly reclassify the risk beyond what age alone can do. Therefore, frailty and comorbidity need to be incorporated into risk assessment after acute coronary syndrome.

References (25)

  • K.H. Cho et al.

    Low-density lipoprotein cholesterol level in patients with acute myocardial infarction having percutaneous coronary intervention (the cholesterol paradox)

    Am J Cardiol

    (2010)
  • N. Ekerstad et al.

    Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction

    Circulation

    (2011)

    • Cited by (0)

    Grant Support: The work was supported by the Spanish Ministry of Economy and Competitiveness through the Carlos III Health Institute (grant nos. RD12/0042/0010, CB16/11/00420, and FIS 15/00837), Fondo Europeo de Desarrollo Regional, and Health Research Fund.

    View full text
    © 2017 Mayo Foundation for Medical Education and Research