Association of frailty with the risk of ischemic and hemorragic events in the elderly patients with acute coronary syndrome
Aim. To assess the prevalence and clinical associations of frailty in the elderly patients with acute coronary syndrome (ACS).Material and methods. We evaluated frailty (national val- idated questionnaire), physical disability (Barthel index), func- tional mobility, nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination), mortality and hemorrhagic risk (GRACE, TIMI, CRUSADE scales) in 130 patients aged of ≥75 years (82.7±4.7 years, arterial hyperten- sion in 91.5%, previous myocardial infarction in 32.3%, atrial fibrillation in 32.3%, diabetes in 26.9%) admitted withmyocardial infarction (75.4%) or unstable angina (24.6%).КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ И ТЕРАПИЯ, 2018, 27 (2) 31ОРИГИНАЛЬНЫЕ СТАТЬИResults. Frailty was diagnosed in 66.1% of patients. According to the GRACE scale, the risk of in-hospital death was high in 60% of patients with non-ST-segment elevation myocardial infaction and 60% of patients with ST-segment elevation myocardial infarction, while the risk of death within6 months was high in 91% and 100% of patients, respective- ly. TIMI score (>5 points) indicated the high risk of death in53% patients, and CRUSADE score (>40 points) indicated the high risk of bleedings in 73.1% of patients. Patients with frailty were more likely to be women (p<0.05 vs. patients without frailty), had a higher incidence of arterial hypertension (p<0.01), myocardial infarction at index hospitalization (p<0.05), GFR <60 ml/min/1.73 m2 (p<0.05). Frailty was also associated with a higher risk of bleeding (CRUSADEscale, p<0.001) and death (GRACE and TIMI scales,p<0.001). Patients with GRACE score >140 points had more pronounced cognitive dysfunction (p<0.05) and decreased functional mobility (p<0.01). Patients with TIMI score >5 points presented with a higher score on a frailty scale (p<0.001) and more significant daily physical disability (p<0.001). Patients with СRUSADE score >40 points had a higher frailty score (p<0.001) and more significant impair- ment of functional mobility (p<0.01) and daily physical activi- ty (p<0.001).Conclusion. Frailty occurs in 66.1% of the elderly patients with ACS and is associated with an increased prevalence of cardiovascular diseases, higher risk of mortality and bleeding.