Abstract 16814: A Prospective Evaluation of Frailty, Comorbidity and Quality of Life in Long-Term Outcomes in Patients with Coronary Heart Disease Undergoing Percutaneous Revascularization
Objectives: To assess the incremental prognostic value of age-associated impairment [frailty, comorbidity, and quality of life (QOL)] on mortality and mortality/myocardial infarction (MI) following PCI over and above the traditional cardiovascular risk factors included in the Mayo Clinic risk score (MCRS). Patients ≥ 65 years who underwent PCI were assessed for frailty (Fried criteria), comorbidity (Charlson index), and QOL [SF-36] prior to hospital discharge.
Results: Of the 628 patients discharged following PCI from October 2005 to September 2008 with a median follow-up of 25.4 months (IQR, 12-33.4), 65 died and 118 had death/MI. MCRS predicted mortality and mortality/MI. Following adjustment for MCRS, indices of frailty [hazard ratio (HR) 5.55 [95% confidence interval (CI), 1.66, 18.5, P = 0.005], physical component score of the SF-36 (HR per 10 point decrease, 1.92; 95% CI, 1.34-2.75, P=0.001), and comorbid conditions [Charlson index, HR per 3 point, 1.46; 95% CI, 1.20, 1.79] were risk factors for mortality following PCI. Frailty was also associated with mortality/MI (HR, 2.46, 95% CI, 1.24, 4.88). Charlson index and SF-36 did not predict long-term mortality/MI. Models with conventional MCRS had C-statistics of 0.659 and 0.581 for mortality and mortality/MI respectively. With the addition of frailty, QOL, and comorbidity indices, the C statistic was (0.704, 0.735, and 0.716) for mortality and (0.592, 0.581, 0.565) for mortality/MI respectively. Including frailty, QOL, and comorbidities into the multivariate risk prediction model conferred a discernible improvement of the mortality model (integrated discrimination improvement 0.022, 0.016, and 0.023 respectively; net reclassification improvement 22%, 16%, 20%); however, the improvement was only marginal for mortality/MI.
Conclusion: Frailty, comorbid conditions and the physical component score from the SF-36 are independent risk factors for long-term mortality and mortality/MI following PCI. These factors improve the discriminatory ability of the MCRS and may help towards informed consent, risk stratification and decision making for elderly patients undergoing PCI.
- © 2010 by American Heart Association, Inc.