| ObjectiveThe present study aimed to investigate the incidence of frailty of aged NSTE-ACS patients received selective PCI in China;discuss whether frailty is an independent short-term(1 month)and long-term(6-month)predictor of MACEs(Major Adverse Cardiac Events)risk in NSTE-ACS elderly patients after PCI;investigate the prognostic factors of aged NSTE-ACS patients received PCI in China;provide a foundation for the pre-operative risk assessment tools for elderly patients with PCI;provide information to the clinical decisions and disease management.MethodsThe prospective cohort study included 425 consecutive NSTE-ACS patients over60 years of age who underwent PCI in Grade III Level A hospital in Chongqing between April 2018 and August 2018.All patients were assessed for frailty using the Frail Scale before PCI,and were classified into the frailty group and the non-frailty group according to the frailty evaluation results.The self-designed general condition questionnaire was used to comprehensively collect data on MACEs after PCI in elderly patients with NSTE-ACS,and the content was as follows:sociology demographic data,clinical data,biochemical indicators,coronary lesions,stent placement),and calculate the Charlson Comorbidity Index(CCI)score,Gensini score,GRACE score based on the collected data.Follow-up at 1st and 6th month and record clinical endpoints including all-cause death,target vessel revascularization,nonfatal angina,unintended readmission,and MACEs occurrence which is a composite outcome indicator with the above 4 ending events.The Kaplan-Meier method was used to made the cumulative MACEs curve of the frailty group and the non-frailty group during the follow-up period and the difference between the two curves was tested by log-rank method.Cox regression models was used to analyzes the influence factors of MACEs after PCI in elderly patients with NSTE-ACS and to explore whether frailty is an independent predictor of MACEs in these patients.The ROC curve was drawn and the area ACU under the curve was calculated to evaluate the Frail score and GRACE score’s predictive value for MACEs after PCI.Results1.Baseline data resultsA total of 425 elderly patients with NSTE-ACS who were eligible for PCIwere enrolled in this study.The Frail Scale was used to evaluate the frailty subjects before PCI.According to the score,131 patients(30.82%)and 294patients(69.18%)were divided into frailty group and non-frailty group respectively.Compared with the non-frailty group,the frailty group was older(70.78±6.41y vs.67.00±5.97y,P=0.000);the female proportion was higher(48.09%vs.23.47%,P<0.001);left ventricle ejection function(LVEF)was worse(57.82±7.97%vs.59.49±6.91%,P=0.029);hypertension(74.80%vs.61.90%,P=0.010),diabetes proportion was higher(45.04%vs.26.19%,P=0.000)and ischemic cerebrovascular disease(32.82%vs.16.32%,P=0.000);the CCI score was higher[(2(1,2)points vs.1(0,2)points,P=0.000]and the average hemoglobin level was lower(125.95±16.90g/L vs.130.20±15.89g/L,P=0.013).2.Follow-up results(1)1st month follow-up results:420 patients completed in 1st month follow-up,the results are as follows:all-cause deaths 2(0.47%),target vessel revascularization0(0.00%),recurrent angina pectoris 13(3.06%),unintended readmission 8(1.88%),and MACEs 20(4.71%).The follow-up results of the two groups were statistically analyzed by~2 test.And the results showed that there was no significant difference in the incidence of MACEs between the two groups at 1st month after PCI(P>0.05).(2)6th month follow-up results:388 patients completed in 6th months of follow-up,the results are as follows:(1)all-cause dead 23(5.41%),target vessel revascularization 8(1.88%);recurrent angina pectoris 37(8.71%);unintended readmission 45(10.59%);and MACEs 88(20.71%).The follow-up results of the two groups were analyzed by~2 test.And the results showed that all incidence rate of clinical endpoints in frailty group were significantly higher than that in non-frailty group,including all-cause dead(12.21%vs 2.38%,P=0.000),target vessel revascularization(4.58%vs 0.68%,P=0.000),recurrent angina(16.03%vs 5.44%,P=0.000),unintended readmission(19.08%vs 6.80%,P=0.000)and MACEs(37.40%vs 13.27%,P=0.000).(2)Kaplan-Meier survival analysis showed that the incidence of MACEs in frailty group was significant higher than that in non-frailty group.The log-rank test of the survival curve showed that the cumulative incidence of MACEs between the two group is significant difference(χ~2=33.60,P=0.000).(3)Univariate Cox regression analysis result showed that frailty was associated with occurrences of MACEs(HR=3.215,95%CI:2.110~4.898,P<0.001).(4)Multivariate Cox regression analysis suggested that frailty(HR=2.457,95%CI 1.573~3.840,P=0.000),age(HR=1.864,95%CI 1.354~2.568,P=0.000),CCI score(HR=1.191,95%CI1.032~1.375,P=0.017),hsCRP(HR=3.706,95%CI 2.043~6.723,P=0.000),GRACE score(HR=1.634,95%CI 1.160~2.303,P=0.005)were adverse independent predictors of cardiovascular disease at 6month postoperatively.(5)The Frail Scale was 0.722(95%CI 0.667~0.777,P=0.000)for the ROE curve of MACEs in elderly patients with NSTE-ACS at 6 months after PCI.The GRACE score was below the ROC curve of MACEs at 6 months after PCI.The area is 0.625(95%CI 0.558~0.692,P=0.000).Conclusions(1)Compared with the general elderly population,The prevalence of frailty in aged NSTE-ACS patients with PCI is higher;the incidence of MACEs after PCI in frailty elderly NSTE-ACS patients is significantly higher than that of non-frailty patients.(2)Frailty cannot be used as an independent predictor of short-time(1 month)MACEs in elderly patients with NSTE-ACS after PCI,Frailty can be used as an independent predictor of 6 month MACEs in elderly patients with NSTE-ACS after PCI.(3)Frailty,age,diabetes mellitus,CCI score,hsCRP and GRACE score were the prognostic factors of elderly patients with NSTE-ACS at 6 months after PCI.Frailty,age,CCI score,hsCRP and GRACE score were independent predictors of MACEs in elderly patients with NSTE-ACS 6 months after PCI. |
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