Gianluca Campo1,2, Elisa Maietti3,4, Elisabetta Tonet2, Simone Biscaglia2, Albert Ariza-Solè5, Rita Pavasini2, Matteo Tebaldi2, Paolo Cimaglia2, Giulia Bugani2, Matteo Serenelli2, Rossella Ruggiero2, Francesco Vitali2, Francesc Formiga6, Juan Sanchis7, Marcello Galvani8, Monica Minarelli9, Giulia Ricci Lucchi10, Roberto Ferrari1,2, Jack Guralnik11, Stefano Volpato3. 1. Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy. 2. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy. 3. Department of Medical Science, University of Ferrara, Italy. 4. Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy. 5. Coronary Care Unit, Heart Diseases Institute, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. 6. Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 7. Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Universidad de Valencia, CIBER CV, Spain. 8. Unità Operativa di Cardiologia, Ospedale GB Morgagni, Forlì, Italy. 9. Department of Emergency, Division of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale di Ferrara, Italy. 10. Division of Cardiology, S. Maria Delle Croci Hospital, Ravenna, Italy. 11. University of Maryland School of Medicine, Baltimore.
Abstract
BACKGROUND: The number of older adults admitted to hospital for acute coronary syndrome (ACS) has increased worldwide. The aim of this study was to determine which scale of frailty or physical performance provides incremental improvements in risk stratification of older adults after ACS. METHODS: A prospective cohort of 402 older (≥70 years) ACS patients were enrolled. Data about baseline characteristics, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) risk scores were collected. Before hospital discharge, seven scales of frailty and physical performance were measured. The 1-year occurrence of adverse events (cardiac death, reinfarction, and cerebrovascular accident [MACCE] and all-cause mortality) was recorded. RESULTS: Out of the 402 patients, 43 (10.5%) had a MACCE and 35 (8.7%) died. Following adjustment for confounding factors, scales of frailty and physical performance were associated with adverse events. Among the scales, the addition of short physical performance battery (SPPB) produced the highest incremental value over the initial model generated by baseline characteristics both for MACCE (ΔC-statistic 0.043, p = .04; integrated discrimination improvement (IDI) 0.054, p = .001; net reclassification improvement (NRI) 0.752, p < .001) and all-cause mortality (ΔC-statistic 0.063, p = .02; IDI 0.061, p < .001; NRI 1.022, p < .001). The addition of SPPB scale on top of GRACE or TIMI risk scores led to a considerable improvement in the prediction of MACCE and all-cause mortality (about 15% and 20%, respectively). CONCLUSIONS: The assessment of the physical performance with SPPB scale before hospital discharge increases the ability to predict adverse events in older ACS patients and may be useful in the clinical decision-making process. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov NCT02386124.
BACKGROUND: The number of older adults admitted to hospital for acute coronary syndrome (ACS) has increased worldwide. The aim of this study was to determine which scale of frailty or physical performance provides incremental improvements in risk stratification of older adults after ACS. METHODS: A prospective cohort of 402 older (≥70 years) ACS patients were enrolled. Data about baseline characteristics, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) risk scores were collected. Before hospital discharge, seven scales of frailty and physical performance were measured. The 1-year occurrence of adverse events (cardiac death, reinfarction, and cerebrovascular accident [MACCE] and all-cause mortality) was recorded. RESULTS: Out of the 402 patients, 43 (10.5%) had a MACCE and 35 (8.7%) died. Following adjustment for confounding factors, scales of frailty and physical performance were associated with adverse events. Among the scales, the addition of short physical performance battery (SPPB) produced the highest incremental value over the initial model generated by baseline characteristics both for MACCE (ΔC-statistic 0.043, p = .04; integrated discrimination improvement (IDI) 0.054, p = .001; net reclassification improvement (NRI) 0.752, p < .001) and all-cause mortality (ΔC-statistic 0.063, p = .02; IDI 0.061, p < .001; NRI 1.022, p < .001). The addition of SPPB scale on top of GRACE or TIMI risk scores led to a considerable improvement in the prediction of MACCE and all-cause mortality (about 15% and 20%, respectively). CONCLUSIONS: The assessment of the physical performance with SPPB scale before hospital discharge increases the ability to predict adverse events in older ACS patients and may be useful in the clinical decision-making process. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov NCT02386124.
Authors: Simone Biscaglia; Vincenzo Guiducci; Andrea Santarelli; Ignacio Amat Santos; Francisco Fernandez-Aviles; Valerio Lanzilotti; Ferdinando Varbella; Luca Fileti; Raul Moreno; Francesco Giannini; Iginio Colaiori; Mila Menozzi; Alfredo Redondo; Marco Ruozzi; Enrique Gutiérrez Ibañes; José Luis Díez Gil; Elisa Maietti; Giuseppe Biondi Zoccai; Javier Escaned; Matteo Tebaldi; Emanuele Barbato; Dariusz Dudek; Antonio Colombo; Gianluca Campo Journal: Am Heart J Date: 2020-08-18 Impact factor: 4.749
Authors: Sean G Kelly; Kunling Wu; Katherine Tassiopoulos; Kristine M Erlandson; Susan L Koletar; Frank J Palella Journal: J Acquir Immune Defic Syndr Date: 2021-07-01 Impact factor: 3.771