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The Impact of Combining CIRS-G and Clinical Frailty Score on One-Month Mortality in Acute Coronary Syndrome
1Department of Cardiology, Faculty of Medicine, Karamanoğlu Mehmetbey University, Karaman 70200, Turkey.
Insights
The GRACE score best predicts one-month mortality in elderly acute coronary syndrome (ACS) patients. However, combining it with comorbidity (Cumulative Illness Rating Scale for Geriatrics) and frailty (Clinical Frailty Score) may enhance risk stratification.
Area of Science:
- Geriatric Cardiology
- Cardiovascular Risk Stratification
- Clinical Epidemiology
Background:
- Acute coronary syndrome (ACS) poses a significant mortality risk in elderly individuals, especially those with multiple comorbidities and frailty.
- Existing risk models like the GRACE score lack comprehensive assessment of geriatric-specific factors such as comorbidity burden and frailty.
- There is a need for improved prognostic tools that integrate traditional risk factors with geriatric assessments for older ACS patients.
Purpose of the Study:
- To evaluate the prognostic value of the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the Clinical Frailty Score (CFS) in predicting one-month mortality in elderly ACS patients.
- To assess whether combining CIRS-G and CFS with the GRACE score improves the prediction of one-month mortality compared to the GRACE score alone.
- To investigate the independent and combined predictive capabilities of geriatric assessment tools and established risk scores in a cohort of older ACS patients.
Main Methods:
- A retrospective cohort study included 90 patients aged 65 years or older admitted with ACS.
- Data collected included demographics, clinical characteristics, echocardiography, and laboratory results.
- Prognostic scores (GRACE, CIRS-G, CFS) were calculated at admission, with one-month all-cause mortality as the primary endpoint. Statistical analyses involved logistic regression and ROC curve analysis.
Main Results:
- Non-survivors (8.9% mortality) exhibited significantly higher CIRS-G, CFS, and GRACE scores, and lower ejection fraction compared to survivors.
- Logistic regression identified the GRACE score as the sole independent predictor of one-month mortality (OR=1.081 per 10-point increase, p=0.044).
- The GRACE score demonstrated the highest discriminative performance (AUC=0.919), followed by CIRS-G (AUC=0.796) and CFS (AUC=0.777). A combined CIRS-G + CFS model showed comparable discrimination (AUC=0.785).
Conclusions:
- The GRACE score remains the strongest independent predictor of one-month mortality in elderly ACS patients.
- Comorbidity (CIRS-G) and frailty (CFS) assessments provide valuable prognostic information.
- Integrating geriatric assessments with traditional risk models like GRACE holds potential for refining individualized risk stratification and guiding management strategies in older ACS patients.
Abstract:
Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of short-term mortality, particularly in elderly patients with multimorbidity and frailty. Conventional models such as the GRACE score provide robust prognostication but do not incorporate comorbidity or frailty burden. This study investigated the prognostic value of combining the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and Clinical Frailty Score (CFS) with GRACE in predicting one-month mortality in older ACS patients. Methods: A single-center, retrospective cohort study was conducted including 90 patients aged ≥65 years admitted with ACS. Demographic, clinical, echocardiographic, and laboratory data were collected. CIRS-G, CFS, and GRACE scores were calculated at admission. The primary endpoint was one-month all-cause mortality. Statistical analyses included group comparisons, correlation tests, logistic regression, and ROC curve analysis. Results: The mean age was 74.8 ± 6.6 years, and 73.3% were male. At one month, mortality was 8.9% (n = 8). Non-survivors had significantly higher CIRS-G (median 18.5 vs. 14.0, p = 0.006), CFS (6.0 vs. 4.0, p = 0.008), and GRACE scores (183 vs. 122, p < 0.001), and lower ejection fraction (32.5 vs. 50.0, p < 0.001) compared with survivors. Logistic regression identified GRACE as the only independent predictor of mortality (OR = 1.081 per 10-point increase, p = 0.044). ROC analysis showed GRACE had the highest discriminative performance (AUC = 0.919), while CIRS-G (AUC = 0.796) and CFS (AUC = 0.777) also demonstrated significant predictive value. The combined CIRS-G + CFS model provided comparable discrimination (AUC = 0.785; sensitivity 75%, specificity 87%). Conclusions: GRACE remains the strongest independent predictor of one-month mortality in elderly ACS patients; however, comorbidity and frailty scores also contribute meaningful prognostic information. Integrating these geriatric assessments with traditional risk models may improve individualized risk stratification and management.
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