5 Major Adverse Cardiovascular Events at 30-days were not Significantly different between Frail and non-frail older (≥75 years) Patients with non ST Elevation Acute Coronary Syndrome Managed by Invasive Strategy: An Analysis from the ICON1 Study

Background Frailty is an independent predictor of major adverse cardiovascular events (MACE) in older patients with Acute Coronary Syndrome (ACS). Evidence based management of ACS involves novel antiplatelets, secondary prevention, revascularisation by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The impact of frailty status on 30-day MACE (mortality, readmission with ACS, unplanned revascularisation, stroke and major bleeding events) in older patients managed by contemporary treatment is not known. The aim of this study is to evaluate and compare the short-term adverse event rates between frail and non-frail older (≥75 years) patients with non ST elevation ACS (NSTEACS) managed by invasive strategy. Methods Over a period of 20 months (February, 2013 to September, 2014), 196 consecutive patients (≥75 years) with NSTEACS managed by invasive strategy were recruited into an ongoing prospective study (ICON1-A Study to Improve Cardiovascular Outcomes in High Risk PatieNts with Acute Coronary Syndrome, United Kingdom Clinical Research Network ID: 12742). Frailty status was assessed by Fried (Cardiovascular Health Study) frailty assessment tool and patients were grouped as frail (score ≥3) and non-frail (score 0–2) patients. The treating cardiologists were blinded to the frailty status of the patient. MACE were recorded at 30-days. Results The mean age of the patients was 81.3 years (standard deviation [SD] 4.1). Females comprised 40.8% of the patients and 32.1% of patients were frail (Table 1). The diagnosis was non ST elevation myocardial infarction in 80.6% and unstable angina in 19.4% of the patients. Final management strategy after coronary angiography in all patients was PCI in 85.7%, CABG in 3.6% and medical management in 10.7% of the study patients. Mortality data was available for all the patients and other MACE data were available for 92.8% of patients. The rate of MACE between frail and non-frail patients were: mortality 1.6% vs. 0% (p = 0.321), ST elevation myocardial infarction 0% vs. 0%, non ST elevation myocardial infarction 0% vs. 0%, unstable angina 0% vs. 1.7% (p = 1.0), unplanned revascularisation 0% vs. 0.8% (p = 1.0), stroke 1.6% vs. 0.8% (p = 0.551) and major bleeding 3.4% vs. 1.6% (p = 0.596) respectively. The rate of composite adverse outcomes were 5.1% vs. 3.3% (p = 0.684) between the two groups respectively. Conclusion The incidence of MACE at 30-days in frail older (≥75 years) patients with NSTEACS managed by invasive strategy was not significantly different from the non-frail patients. This is likely to be the result of using contemporary treatment strategies and strict adherence to guideline recommended therapy. Given favourable short term outcomes in this high risk cohort, frailty should not deter older patients from receiving invasive treatment and contemporary care in the setting of NSTEACS. Our study consisted of selected patient cohort and will need to be evaluated further in large unselected patient cohort.