Influence of Frailty and Health Status on Outcomes in Patients With Coronary Disease Undergoing Percutaneous Revascularization
- 1 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Quality and Outcomes
- Vol. 4 (5), 496-502
- https://doi.org/10.1161/circoutcomes.111.961375
Abstract
Background—: Although older patients frequently undergo percutaneous coronary interventions (PCI), frailty, comorbidity, and quality of life are seldom part of risk prediction approaches. We assessed their incremental prognostic value over and above the risk factors in the Mayo Clinic risk score. Methods and Results—: Patients ≥65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and quality of life [SF-36]. Of the 628 discharged [median follow-up of 35.0 months (interquartile range, 22.7 to 42.9)], 78 died and 72 had a myocardial infarction (MI). Three-year mortality was 28% for frail patients, 6% for nonfrail patients. The respective 3-year rates of death or MI were 41% and 17%. After adjustment, frailty [hazard ratio (HR), 4.19 [95% confidence interval (CI), 1.85, 9.51], physical component score of the SF-36 (HR, 1.59; 95% CI, 1.24 to 2.02), and comorbidity, (HR, 1.10; 95% CI, 1.05, 1.16) were associated with mortality. Frailty was associated with mortality/MI (HR, 2.61, 1.52, 4.50). Models with conventional Mayo Clinic risk score had C-statistics of 0.628, 0.573 for mortality and mortality/MI, respectively. Adding frailty, quality of life, and comorbidity, the C-statistic was (0.675, 0.694, 0.671) for mortality and (0.607, 0.587, 0.576) for mortality/MI, respectively. Including frailty, comorbidities and SF-36, conferred a discernible improvement to predict death and death/MI (integrated discrimination improvement, 0.027 and 0.016, and net reclassification improvement of 43% and 18%, respectively). Conclusions—: After PCI, frailty, comorbidity and poor quality of life are prevalent and are associated with adverse long-term outcomes. Their inclusion improves the discriminatory ability of the Mayo Clinic risk score derived from the routine cardiovascular risk factors.Keywords
This publication has 26 references indexed in Scilit:
- Evolving Applications for Patient-Centered Health Status MeasuresCirculation, 2008
- Frailty and Its Potential Relevance to Cardiovascular CareMayo Clinic Proceedings, 2008
- Comorbid conditions and outcomes after percutaneous coronary interventionHeart, 2008
- Cumulative Deficits Better Characterize Susceptibility to Death in Elderly People than Phenotypic Frailty: Lessons from the Cardiovascular Health StudyJournal of the American Geriatrics Society, 2008
- Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyondStatistics in Medicine, 2007
- A Risk Score to Predict In-Hospital Mortality for Percutaneous Coronary InterventionsJournal of the American College of Cardiology, 2006
- Sex Differences in the Risk of Frailty for Mortality Independent of Disability and Chronic DiseasesJournal of the American Geriatrics Society, 2004
- Predictors of health-related quality of life after coronary artery bypass surgeryThe Annals of Thoracic Surgery, 2004
- Scores for Post–Myocardial Infarction Risk Stratification in the CommunityCirculation, 2002
- Risk and Predictors of Stroke After Myocardial Infarction Among the ElderlyCirculation, 2002