Prevalence and Impact of Frailty in Older Patients with Chronic and Acute Coronary Syndrome Referred for Coronary Angiography

INTRODUCTION: Frailty has been proposed as an important marker for predicting outcomes in older patients with cardiovascular disease. However, it remains unclear whether the relationship between frailty and unfavorable outcomes is consistent between patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). METHODS: Patients of 70 years or older referred for coronary angiography (CAG) due to CCS or ACS were included and followed for 12 months. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified by their CFS into frail/vulnerable (CFS ≥4) and robust (CFS = 1-3). The study endpoints comprised all-cause mortality and new hospital admissions for myocardial infarction, bleeding, unplanned revascularization or stroke. RESULTS: 678 patients of 70 years or older with available CFS underwent CAG and completed 12-month follow-up. Of these, 223 patients were referred due to CCS, and 455 to ACS. The prevalence of frailty/vulnerability was higher in patients referred with CCS compared to those with ACS (CCS: 43.0% vs. ACS: 32.2%, p = 0.009). Frail/vulnerable patients referred with CCS were younger (CCS: 76.6(±4.7) years vs. ACS: 79.6(±5.7) years, p < 0.001) and less frequently treated with percutaneous coronary intervention (CCS: 40.6% vs. ACS: 54.6%, p = 0.043). When compared to robust patients, cumulative all-cause mortality was higher in frail/vulnerable patients referred with ACS, but not in patients referred with CCS (log-rank p < 0.001). CONCLUSION: Among patients of 70 years or older referred for CAG 30-40% are frail/vulnerable. Frailty/vulnerability was related to higher all-cause mortality in ACS patients referred for CAG, but not in those referred due to CCS. This difference in outcome may reflect variations in clinical presentation as well as potential referral bias.