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Frailty confers less catheterization, more bleeding in acute MI
Among older patients with acute MI, those with frailty had lower odds of undergoing cardiac catheterization but, when catheterization was performed, higher risk for major bleeding, researchers reported.
The researchers analyzed 129,330 patients aged 65 years or older (mean age, 75 years; 40% women) admitted for acute MI to 775 hospitals in the ACTION registry from 2015 to 2016.
To determine frailty, patients received a score of 0, 1 or 2 in walking, cognition and activities of daily living. A total score of 0 signified fit/well, a score of 1 or 2 conferred mild frailty and a score of 3 to 6 meant moderate to severe frailty.
Among the cohort, 16.4% had any frailty, John A. Dodson, MD, MPH, FACC, from the division of cardiovascular medicine at NYU Langone Health, and colleagues wrote.
“Beginning in 2015, the ACTION registry began to capture this information, allowing us to have 2 years’ worth of data,” Dodson said in a press release. “By analyzing this information, we were able to confirm that there is indeed a correlation between frailty and greater risk of bleeding in this population.”
Compared with nonfrail patients, frail patients were older and more likely to be women (P < .001 for both) and were less likely to undergo diagnostic catheterization or PCI (P < .001 for both), according to the researchers.
The more severe the frailty, the more likely major bleeding was to occur (well group, 6.5%; mild frailty group, 9.4%; moderate to severe frailty group, 9.9%; P < .001), Dodson and colleagues found.
In patients who had cardiac catheterization, frailty was independently associated with elevated risk for major bleeding (adjusted OR for mild group vs. well group = 1.33; 95% CI, 1.23-1.44; aOR for moderate to severe group vs. well group = 1.4; 95% CI, 1.24-1.58), according to the researchers.
Bleeding risk did not differ in patients who did not have cardiac catheterization (aOR for mild group vs. well group = 1.01; 95% CI, 0.86-1.19; aOR for moderate to severe group vs. well group = 0.96; 95% CI, 0.81-1.14).
“These findings highlight the conundrum with invasive management strategies in frail [acute] MI patients,” Dodson and colleagues wrote. “Awareness of vulnerability and greater utilization of evidence-based strategies to reduce bleeding, including radial access and properly dose-adjusted anticoagulant therapies, may mitigate some bleeding events. When applicable, estimation of bleeding risk in frail patients before invasive care may facilitate clinical decision-making and the informed consent process.” – by Erik Swain
Disclosures: Dodson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.