Routine invasive strategy and frailty burden in non-ST-seg-ment elevation acute myocardial infarction
Albert Ariza-Solé1
Juan Andrés Bermeo1
Francesc Formiga2
Héctor Bueno3
Gemma Miñana4
Oriol Alegre1
David Martí5
Manuel Martínez-Sellés6
Laura Domínguez-Pérez3
Pablo Díez-Villanueva7
José A Barrabés8
Francisco Marín9
Adolfo Villa10
Marcelo Sanmartín11
Cinta Llibre12
Alessandro Sionís13
Antoni Carol14
Sergio García-Blas4
María José Morales Gallardo5
Jaime Elízaga6
Iván Gómez-Blázquez3
Fernando Alfonso7
Bruno García Del Blanco8
Julio Núñez4
Juan Sanchis4
1.Cardiology Department,Hospital Universitari de Bellvitge,L'Hospitalet de Llobregat,Barcelona,Spain2.Internal Med-icine Department,Hospital Universitari de Bellvitge,L'Hospitalet de Llobregat,Barcelona,Spain3.Centro Nacional de Inves-tigaciones Cardiovasculares(CNIC),Madrid,Spain;Cardiology Department,Hospital 12 de Octubre,and Instituto de Inve-stigación Sanitaria Hospital 12 de Octubre(imas12),Madrid,CIBERCV,Madrid,Spain;Universidad Complutense,Mad-rid,Spain4.Cardiology Department,Hospital Clínico Universitario de Valencia,INCLIVA,Universidad de Valencia,CIBE-RCV,Valencia,Spain5.Cardiology Department,Hospital Central de la Defensa,Madrid,Spain6.Cardiology Departme-nt,Hospital Universitario Gregorio Marañón,CIBERCV,Universidad Complutense,Universidad Europea,Madrid,Spain7.Cardiology Department,Hospital Universitario La Princesa,ⅡS-IP,CIBERCV,Madrid,Spain8.Cardiology Department,Hospital Universitari Vall d'Hebron,CIBERCV,Barcelona,Spain9.Cardiology Department,Hospital Virgen de la Arrixaca,CIBERCV,El Palmar,Murcia,Spain10.Cardiology Department,Hospital Universitario del Sureste,Arganda del Rey,Mad-rid,Spain11.Cardiology Department,Hospital Ramon y Cajal,CIBERCV,Madrid,Spain12.Cardiology Department,Hos-pital Germans Trias i Pujol,CIBERCV,Badalona,Barcelona,Spain13.Cardiology Department,Hospital Sant Pau,CIBERCV,Barcelona,Spain14.Cardiology Department,Hospital Moisés Broggi,Sant Joan Despí,Barcelona,Spain
摘要：Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.
Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)＞4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(D AOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS＞4,n=124)patients.
Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56％).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS＞4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.
Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.
机标关键词：strategyroutineacuteburdenelevationfrailtyinfarctioninvasive
论文发表日期：2024-10-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：8( 954-961 )