Addition of Tilburg frailty indicator to the classic Global Registry of Acute Coronary Events risk score improves its prognostic value in elderly patients with acute coronary syndrome.

Abstract

Since the proper risk stratification in the growing population of patients with acute coronary syndrome (ACS) is challenging, the potential advantage of adding the elements of geriatric assessment to the commonly used Global Registry of Acute Coronary Events (GRACE) scale in predicting the risk of 6-month death requires investigation. The study group included 196 patients aged ≥65 years (mean age 74.4 years), hospitalized for ACS. The risk of 6-months mortality was assessed with the GRACE scale, the frailty syndrome (FS) using the Tilburg Frailty Indicator questionnaire, the cognitive impairment (CI) using the Polish adaptation of the Mini Mental State Examination and multimorbidity with the CAD specific index. After 6 months, a follow-up telephone call was performed. To enable the assessment of whether adding TFI, MMSE, CAD specific index to the GRACE scale improves its prognostic value, normalization was carried out. In relation to GRACE (AUC 0.713), combination of GRACE (norms) and TFI (norms) had higher predictive power for 6 months mortality (AUC = 0.737). The risk of death was seven times greater [RR = 7.02] in patients with >55.8 points in the test based on GRACE and TFI score. In the multivariable logistic regression analysis the model based on GRACE 2.0, TFI and MMSE (the lowest AIC value) was best-performing in risk of death prediction. Adding the FS assessment to the traditional GRACE scale improves its prognostic value in elderly with ACS.