Impact of Frailty Syndrome on Early and Midterm Adverse Events in Patients With Acute Coronary Syndrome

BACKGROUND With an aging population, there is a growing proportion of patients with frailty and acute coronary syndrome (ACS). However, there is a paucity of data on optimal management and risk stratification. We aimed to assess the impact of frailty on early and midterm adverse events in patients with ACS. MATERIAL AND METHODS This was a prospective, observational study including 196 patients aged 65 years or older (mean age 74.4 years) with ACS. Frailty was assessed with the Tilburg Frailty Indicator (TFI). Patients were classified as non-frail (TFI score 0-4), with mild frailty (TFI score 5-8 points), and with moderate/severe frailty (TFI >8 points). In-hospital complications and major cardiovascular and cerebrovascular events (MACCEs) at 6-month follow-up were analyzed. RESULTS The rate of overall in-hospital complications and prolonged length of stay was increased in frail patients vs non-frail (61.3% vs 25.4%; P<0.001; and 54% vs 16.9%; P<0.001). At 6-month follow-up, MACCEs were observed more often in patients with moderate/severe frailty (22.2% vs 5.1%; P=0.019), and all-cause death more often in patients with frailty vs non-frail (10.9% vs 1.7%; P=0.03). Elevated TFI score was an independent predictor of in-hospital and midterm MACCEs in patients with ACS (TFI ≥5 points for in-hospital, and ≥8 points for midterm complications). CONCLUSIONS Frailty syndrome is associated with impaired early and midterm outcomes in older adult patients with ACS, independent of chronological age. Assessment of frailty in patients with ACS provides data valuable for risk stratification and management.