Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta‐analysis

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 46; no. 1; pp. 5 - 12
• Main Authors: Yu, Qian, Guo, Dawei, Peng, Jianan, Wu, Qifei, Yao, Yonghuan, Ding, Mei, Wang, Jiang
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-01-2023; John Wiley and Sons Inc
• Subjects: acute myocardial infarction; Aged; Aged patients; Analysis; Angioplasty; Cardiac patients; Cardiovascular disease; Chronic fatigue syndrome; Clinical outcomes; Cohort analysis; Cross-sectional studies; Frailty; Frailty - diagnosis; Frailty - epidemiology; Heart attacks; Humans; Medical research; Medicine, Experimental; Meta-analysis; Mortality; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Myocardial Infarction - therapy; Older people; outcome; Patient outcomes; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Prevalence; Qian Yu; Review; Reviews; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - epidemiology; ST Elevation Myocardial Infarction - surgery; Statistical analysis; Systematic review; Transluminal angioplasty; Treatment Outcome; United States > US; Japan; frailty; prevalence; percutaneous coronary intervention; acute myocardial infarction; outcome
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23929

Background
The association between frailty and older patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is unclear. Therefore, we conducted a systematic review and meta‐analysis to investigate the prevalence of frailty in older patients with AMI following PCI, and determine the relationship between frailty and adverse outcomes in these patients.
Hypothesis
Older patients with AMI have a higher prevalence of frailty after PCI, and the frailty in these patients increases the risk of adverse outcomes.
Methods
A comprehensive search of the PubMed, Cochrane, Ovid (Medline), Ovid (Embase), and Web of Science databases was performed for articles published until October 2021. A meta‐analysis was performed using stata12.0 software. A random‐effects model was used when I2 was greater than 50%; otherwise, a fixed‐effects model was used.
Results
There were a total of 274,976 older patients in the included studies. Nine studies investigated the prevalence of frailty in older patients with AMI after PCI, with an overall prevalence of 39% (95% confidence interval [CI]: 18%–60%, p < .001). Six studies included adverse outcomes of frailty in older patients with AMI after PCI, including all‐cause mortality (hazard ratio [HR] = 2.29, 95% CI: 1.65–3.16, p = .285), rehospitalization (HR = 2.53, 95% CI: 1.38–4.63), and in‐hospital major bleeding (HR = 1.93, 95% CI: 1.29–2.90, p = .825).
Conclusion
The frailty prevalence is increased in older patients with AMI after PCI, especially in ST‐segment elevation myocardial infarction (STEMI). AMI with frailty after PCI is more likely to be associated with worse clinical outcomes, such as death, bleeding, and rehospitalization.