Frailty is an independent prognostic marker in elderly patients with myocardial infarction

Clin Cardiol. 2017 Oct;40(10):925-931. doi: 10.1002/clc.22749. Epub 2017 Jul 16.


Background: Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age.

Hypothesis: This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS.

Methods: Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively. Frailty was defined at admission using the previously validated Survey of Health Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the combination of death or nonfatal myocardial reinfarction during a follow-up of 6 months. Major bleeding (hemoglobin decrease ≥3 g/dL or transfusion needed) and readmission rates were also explored.

Results: A total of 234 consecutive patients were included. Frail patients (40.2%) had a higher-risk profile, based on higher age and comorbidities. On multivariate analysis, frailty was an independent predictor of the combination of death or nonfatal myocardial reinfarction (adjusted hazard ratio [aHR]: 2.54, 95% confidence interval [CI]: 1.12-5.79), an independent predictor of the combination of death, nonfatal myocardial reinfarction, or major bleeding (aHR: 2.14, 95% CI: 1.13-4.04), and an independent predictor of readmission (aHR: 1.80, 95% CI: 1.00-3.22).

Conclusions: Frailty phenotype at admission is common among elderly patients with ACS and is an independent predictor for severe adverse events. It should be considered in future risk-stratification models.

Keywords: Acute Coronary Syndrome; Acute Myocardial Infarction; Aging; Frailty; Prognosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aging
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Frail Elderly*
  • Frailty / diagnosis
  • Frailty / epidemiology*
  • Frailty / mortality
  • Hemorrhage / epidemiology
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / mortality
  • Odds Ratio
  • Phenotype
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Spain / epidemiology
  • Tertiary Care Centers
  • Time Factors