Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction  

作　　者：Albert Ariza-Solé Juan Andrés Bermeo Francesc Formiga Héctor Bueno Gemma Miñana Oriol Alegre David Martí Manuel Martínez-Sellés Laura Domínguez-Pérez Pablo Díez-Villanueva JoséA Barrabés Francisco Marín Adolfo Villa Marcelo Sanmartín Cinta Llibre Alessandro Sionís Antoni Carol Sergio García-Blas María JoséMorales Gallardo Jaime Elízaga Iván Gómez-Blázquez Fernando Alfonso Bruno García Del Blanco Julio Núñez Juan Sanchis 

机构地区：[1]Cardiology Department,Hospital Universitari de Bellvitge,L’Hospitalet de Llobregat,Barcelona,Spain [2]Internal Medicine Department,Hospital Universitari de Bellvitge,L’Hospitalet de Llobregat,Barcelona,Spain [3]Centro Nacional de Investigaciones Cardiovasculares(CNIC),Madrid,Spain.Cardiology Department,Hospital 12 de Octubre,and Instituto de Investigación Sanitaria Hospital 12 de Octubre(imas12),Madrid,CIBERCV,Madrid,Spain.Universidad Complutense,Madrid,Spain [4]Cardiology Department,Hospital Clínico Universitario de Valencia,INCLIVA,Universidad de Valencia,CIBERCV,Valencia,Spain [5]Cardiology Department,Hospital Central de la Defensa,Madrid,Spain [6]Cardiology Department,Hospital Universitario Gregorio Marañón,CIBERCV,Universidad Complutense,Universidad Europea,Madrid,Spain [7]Cardiology Department,Hospital Universitario La Princesa,IIS-IP,CIBERCV,Madrid,Spain [8]Cardiology Department,Hospital Universitari Vall d’Hebron,CIBERCV,Barcelona,Spain [9]Cardiology Department,Hospital Virgen de la Arrixaca,CIBERCV,El Palmar,Murcia,Spain [10]Cardiology Department,Hospital Universitario del Sureste,Arganda del Rey,Madrid,Spain [11]Cardiology Department,Hospital Ramon y Cajal,CIBERCV,Madrid,Spain [12]Cardiology Department,Hospital Germans Trias i Pujol,CIBERCV,Badalona,Barcelona,Spain [13]Cardiology Department,Hospital Sant Pau,CIBERCV,Barcelona,Spain [14]Cardiology Department,Hospital Moisés Broggi,Sant Joan Despí,Barcelona,Spain

出　　处：《Journal of Geriatric Cardiology》2024年第10期954-961,共8页老年心脏病学杂志（英文版）

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(DAOH)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.

关 键 词：ROUTINE INVASIVE INFARCTION 

分 类 号：R542.22[医药卫生—心血管疾病]