Impact of frailty on outcome of elderly NSTEMI patients undergoing PCI.

Abstract

Frailty status is linked with a poorer clinical outcome and frail patients are often less revascularized even with percutaneous coronary intervention (PCI). We therefore sought to assess the impact of frailty on clinical outcome of elderly patients with non ST-elevation acute-myocardial-infarction (NSTEMI) undergoing PCI. We prospectively enrolled 141 consecutive elderly (>75 years) patients admitted for NSTEMI. 104 patients underwent PCI (35 frail, 69 non-frail), 37 were not revascularized (22 frail, 15 non frail). Frail patients were older, less frequently male, more affected by dementia and severe left ventricular dysfunction, less treated with PCI; patients treated with PCI were younger and less affected by dementia. Thirty-day mortality rates were proportionally higher from 3% in non-frail patients treated with PCI, to 7% in non-frail not treated with PCI, 17% in frail treated with PCI, 48% in frail patients not treated with PCI (p <0.05). Similarly 6-month mortality rates were proportionally higher (12%, 29%, 37%, 71%). At multivariable analysis frail status was associated to a 6-fold increased risk of mortality at 30-days; at 6 months, frail status was associated to a 3.4-fold risk of death (p<0.01) but also PCI was associated to a lower risk of mortality (OR 0.2, p<0.01). In an observational study on elderly NSTEMI patients, frail status is associated to a poorer outcome, while PCI is associated to a better long term outcome. A careful selection of patient suitable for revascularization by PCI may be useful in improving outcome of elderly frail patients with NSTEMI.