Abstract
The aim of the present study was to investigate the prognostic value of geriatric
conditions beyond age after acute coronary syndrome. This was a prospective cohort
design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized
for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were
evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and
simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability
(Barthel index), and instrumental disability (Lawton-Brody scale). The primary end
point was all-cause mortality. The median follow-up for the entire population was
4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric
conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20;
P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40;
P=.05) were the independent predictors. The introduction of age in a basic model using
well-established prognostic clinical variables resulted in an increase in discrimination
accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further
increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk
reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67;
and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the
addition of frailty and comorbidity provided a further significant risk reclassification
in comparison to the clinical model with age (continuous net reclassification improvement,
0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI,
0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly
reclassify risk beyond age after acute coronary syndrome.
Abbreviations and Acronyms:
HR (hazard ratio), IDI (integrated discrimination improvement), NRI (net reclassification improvement)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: April 04, 2017
Footnotes
Grant Support: The work was supported by the Spanish Ministry of Economy and Competitiveness through the Carlos III Health Institute (grant nos. RD12/0042/0010 , CB16/11/00420 , and FIS 15/00837 ), Fondo Europeo de Desarrollo Regional, and Health Research Fund.
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