Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. METHODS PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. RESULTS A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I2: 79%). Subgroup analysis using the Fried score reduced I2 to 68% without altering the pooled HR (2.78, 95% CI 1.02-7.76; P < .05). Using the Canadian Study of Health and Aging Clinical Frailty Scale reduced I2 to 0% while preserving the pooled HR (5.99, 95% CI 2.77-12.95, P < .001). CONCLUSIONS Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.

DOI: 10.1016/j.jamda.2017.09.002

Cite this paper

@article{Tse2017FrailtyAM, title={Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.}, author={Gary Tse and Mengqi Gong and Julia Barreal N{\'u}{\~n}ez and Juan A. Sanchis and Guangping Li and Sadeq Ali-Hasan-Al-Saegh and Wing Tak Wong and Sunny Hei Wong and William Ka Kei Wu and George Bazoukis and Gan Yan and Konstantinos Lampropoulos and Adrian M Baranchuk and Lap Ah Tse and Yunlong Xia and Tong Liu and Jean Woo}, journal={Journal of the American Medical Directors Association}, year={2017} }