D-20 | Impact of Frailty on Outcomes of Percutaneous Coronary Intervention: Insights from the Nationwide Inpatient Sample

Abstract

Patients with significant coronary artery disease require percutaneous coronary intervention (PCI). However, whether frailty has adverse outcomes in patients undergoing PCI has been controversial. We investigated the impact of frailty on the outcomes of patients who underwent PCI. We reviewed the National Inpatient Sample to identify patients that underwent PCI. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Univariate and multivariate logistic regression analyses were performed to determine any association between frailty and the clinical outcomes. From 2017-2020, 102,324 patients underwent PCI in the United States, and 7.3% met the criteria for frailty. We found that the frail group had longer lengths of stay (10 vs 4 days, p < 0.001), and higher hospitalization costs ($266k vs $158k, p < 0.001). After multivariate adjustment, we found that frailty was associated with increased in-hospital mortality, cardiogenic shock, increased vasopressor requirements, higher need for mechanical circulatory support, higher need for mechanical ventilation, increased incidence of post-operative stroke and post-operative sepsis, and increased risk of sudden cardiac death. The presence of frailty in patients who underwent PCI was associated with significantly higher in-hospital mortality, longer lengths of stay, higher hospitalization costs, and worsening secondary outcomes. These findings may suggest the need for an alternative approach for frail patients who are indicated for revascularization.