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Clin Cardiol. 2017 Oct;40(10):925-931. doi: 10.1002/clc.22749. Epub 2017 Jul 16.

Frailty is an independent prognostic marker in elderly patients with myocardial infarction.

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Cardiology Department, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain.
Cardiology Department, Hospital Virgen Macarena, Seville, Spain.



Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age.


This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS.


Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively. Frailty was defined at admission using the previously validated Survey of Health Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the combination of death or nonfatal myocardial reinfarction during a follow-up of 6 months. Major bleeding (hemoglobin decrease ≥3 g/dL or transfusion needed) and readmission rates were also explored.


A total of 234 consecutive patients were included. Frail patients (40.2%) had a higher-risk profile, based on higher age and comorbidities. On multivariate analysis, frailty was an independent predictor of the combination of death or nonfatal myocardial reinfarction (adjusted hazard ratio [aHR]: 2.54, 95% confidence interval [CI]: 1.12-5.79), an independent predictor of the combination of death, nonfatal myocardial reinfarction, or major bleeding (aHR: 2.14, 95% CI: 1.13-4.04), and an independent predictor of readmission (aHR: 1.80, 95% CI: 1.00-3.22).


Frailty phenotype at admission is common among elderly patients with ACS and is an independent predictor for severe adverse events. It should be considered in future risk-stratification models.


Acute Coronary Syndrome; Acute Myocardial Infarction; Aging; Frailty; Prognosis

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