Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome
Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome
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DOI：
10.1016/j.ahj.2014.07.022
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发表时间：
2014-11-01
影响因子：
4.8
通讯作者：
Nunez, Julio
中科院分区：
文献类型：
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作者：
Sanchis, Juan;Bonanad, Clara;Nunez, Julio
背景老年疾病可能预测年龄和标准风险因素以外的结果。我们的目的是调查广泛的老年条件后，急性冠脉综合征的幸存者。方法共142例患者年龄超过65岁。出院时，对5种老年疾病进行评估：虚弱（Fried和绿色评分）、身体残疾（Barthel指数）、工具残疾（Lawton-Brody量表）、认知障碍（Pfeiffer问卷）和合并症（Charlson和简单合并症指数）。结果是出院后死亡率和死亡/心肌梗死复合在30个月的中位数follow-up.Results七十四（22%）例患者死亡，105（31%）患有复合终点。通过单变量分析，所有个体老年指标均与结局相关，主要是死亡率。其中，虚弱使用绿色评分具有最强的判别准确性（死亡率的受试者工作特征曲线下面积为0.76）。在包括临床和老年数据在内的全面校正后，绿色评分是唯一独立的预测老年疾病的指标（每点;死亡率：风险比1.25，95% CI 1.15-1.36，P = .0001;复合终点：风险比1.16，95% CI 1.09-1.24，P = .0001）。绿色评分>= 5分是最强的死亡率预测因子。在临床模型中增加绿色评分改善了区分度（受试者工作特征曲线下面积0.823 vs 0.846），并显著重新分类了死亡风险（净重新分类改善26.3，95% CI 1.4-43.5;综合区分度改善4.0，95% CI 0.8-9.0）。增量的预测信息甚至更大的GRACE score.Conclusions虚弱捕获老年条件后急性冠状动脉综合征提供的预后信息。绿色评分优于其他老年学指标。
Background Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome.Methods A total of 142 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up.Results Seventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% Cl 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% Cl 1.09-1.24, P = .0001). A Green score >= 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% Cl 1.4-43.5; integrated discrimination improvement 4.0, 95% Cl 0.8-9.0). The incremental predictive information was even greater over the GRACE score.Conclusions Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.