Association of Frailty with In-Hospital and Long-Term Outcomes Among STEMI Patients Receiving Primary Percutaneous Coronary Intervention

Abstract

BackgroundFrailty is generally a marker of worse prognosis. The impact of frailty on both in-hospital and long-term outcomes in ST-segment-elevation myocardial infarction (STEMI) patients has not been well described. Given this, we aimed to determine the prevalence and impact of frailty on in-hospital and 1-year outcomes in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). MethodsThis retrospective study reviewed STEMI patients ≥ 65 years who underwent pPCI at the two pPCI-capable hospitals at Vancouver Coastal Health. A frailty index (FI) was determined using a deficit accumulation model, with those with a FI > 0.25 being defined as frail. The primary outcome was 1-year all-cause mortality. The secondary outcomes included in-hospital all-cause mortality, a composite of adverse in-hospital outcomes (all-cause mortality, cardiogenic shock, heart failure, re-infarction, major bleeding, or stroke), and the individual components of the composite. Results1,579 patients were reviewed, of which 228 (14.4%) were frail. After multivariable adjustment, greater frailty (i.e., increasing FI) was associated with increased in-hospital all-cause mortality (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.50-2.35, P<0.001), the composite adverse in-hospital outcome (OR, 1.46; 95% CI, 1.27-1.68, P<0.001) and 1-year all-cause mortality (OR, 1.48; 95% CI, 1.10-2.00, P=0.011). ConclusionIn a contemporary STEMI cohort of older patients receiving pPCI, 1 in 7 patients were frail, with greater frailty being independently associated with increased in-hospital and long-term adverse outcomes. These findings raise the need for the early recognition of frailty and implementation of an interdisciplinary approach towards the management of frail STEMI patients.