Gary Tse1, Mengqi Gong2, Julia Nunez3, Juan Sanchis3, Guangping Li2, Sadeq Ali-Hasan-Al-Saegh4, Wing Tak Wong5, Sunny Hei Wong1, William K K Wu6, George Bazoukis7, Gan-Xin Yan8, Konstantinos Lampropoulos7, Adrian M Baranchuk9, Lap Ah Tse10, Yunlong Xia11, Tong Liu12, Jean Woo13. 1. Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China. 2. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. 3. Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain. 4. Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 5. School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China. 6. Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Department of Anesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. 7. Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece. 8. Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China. 9. Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada. 10. Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. 11. Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China. 12. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. Electronic address: liutongdoc@126.com. 13. Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.
Abstract
BACKGROUND: Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. METHODS: PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. RESULTS: A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I2: 79%). Subgroup analysis using the Fried score reduced I2 to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001). CONCLUSIONS: Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.
BACKGROUND: Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. METHODS: PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. RESULTS: A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I2: 79%). Subgroup analysis using the Fried score reduced I2 to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001). CONCLUSIONS: Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.
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Authors: Rosa Liperoti; Davide L Vetrano; Katie Palmer; Tomasz Targowski; Maria C Cipriani; Maria R Lo Monaco; Silvia Giovannini; Nicola Acampora; Emanuele Rocco Villani; Roberto Bernabei; Graziano Onder Journal: BMC Geriatr Date: 2021-06-10 Impact factor: 3.921