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

Abstract: Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-STsegment elevation myocardial infarction (NSTEMI) from the MOSCA-FRAIL clinical trial. Methods: The MOSCA-FRAIL trial randomized 167 frail patients, defined by a C...

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Autores: Nuñez, Julio, Ariza Solé, Albert, Andrés Bermeo, Juan, Formiga Pérez, Francesc, Bueno, Héctor, Miñana, Gemma, Alegre Canals, Oriol, Martí, David, Martínez-Sellés, Manuel, Domínguez-Pérez, Laura, Díez Villanueva, Pablo, Barrabés, José A., Marín, Francisco, Villa, Adolfo, Sanmartín-Fernández, Marcelo, Llibre, Cinta, Sionis, Alessandro, Carol, Antoni, García Blas, Sergio, Morales Gallardo, María José, Elízaga, Jaime, Gómez-Blázquez, Iván, Alfonso, Fernando, García del Blanco, Bruno, Sanchis Forés, Juan
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/219622
Acceso en línea:https://hdl.handle.net/2445/219622
Access Level:acceso abierto
Palabra clave:Fragilitat
Persones grans
Infart de miocardi
Brittleness
Older people
Myocardial infarction
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spelling Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarctionNuñez, JulioAriza Solé, AlbertAndrés Bermeo, JuanFormiga Pérez, FrancescBueno, HéctorMiñana, GemmaAlegre Canals, OriolMartí, DavidMartínez-Sellés, ManuelDomínguez-Pérez, LauraDíez Villanueva, PabloBarrabés, José A.Marín, FranciscoVilla, AdolfoSanmartín-Fernández, MarceloLlibre, CintaSionis, AlessandroCarol, AntoniGarcía Blas, SergioMorales Gallardo, María JoséElízaga, JaimeGómez-Blázquez, IvánAlfonso, FernandoGarcía del Blanco, BrunoSanchis Forés, JuanFragilitatPersones gransInfart de miocardiBrittlenessOlder peopleMyocardial infarctionAbstract: Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-STsegment 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 readmissions (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 causes 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, there 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 invasive strategy does not improve outcomes and might be harmful to the frailest patients.Tsinghua University Press2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/219622Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.26599/1671-5411.2024.10.005Journal of Geriatric Cardiology, 2024, vol. 21, num.10, p. 954-961https://doi.org/10.26599/1671-5411.2024.10.005(c) Journal of Geriatric Cardiology, 2024info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2196222026-05-27T06:46:51Z
dc.title.none.fl_str_mv Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
title Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
spellingShingle Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
Nuñez, Julio
Fragilitat
Persones grans
Infart de miocardi
Brittleness
Older people
Myocardial infarction
title_short Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
title_full Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
title_fullStr Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
title_full_unstemmed Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
title_sort Routine invasive strategy and frailty burden in non-ST-segment elevation acute myocardial infarction
dc.creator.none.fl_str_mv Nuñez, Julio
Ariza Solé, Albert
Andrés Bermeo, Juan
Formiga Pérez, Francesc
Bueno, Héctor
Miñana, Gemma
Alegre Canals, Oriol
Martí, David
Martínez-Sellés, Manuel
Domínguez-Pérez, Laura
Díez Villanueva, Pablo
Barrabés, José A.
Marín, Francisco
Villa, Adolfo
Sanmartín-Fernández, Marcelo
Llibre, Cinta
Sionis, Alessandro
Carol, Antoni
García Blas, Sergio
Morales Gallardo, María José
Elízaga, Jaime
Gómez-Blázquez, Iván
Alfonso, Fernando
García del Blanco, Bruno
Sanchis Forés, Juan
author Nuñez, Julio
author_facet Nuñez, Julio
Ariza Solé, Albert
Andrés Bermeo, Juan
Formiga Pérez, Francesc
Bueno, Héctor
Miñana, Gemma
Alegre Canals, Oriol
Martí, David
Martínez-Sellés, Manuel
Domínguez-Pérez, Laura
Díez Villanueva, Pablo
Barrabés, José A.
Marín, Francisco
Villa, Adolfo
Sanmartín-Fernández, Marcelo
Llibre, Cinta
Sionis, Alessandro
Carol, Antoni
García Blas, Sergio
Morales Gallardo, María José
Elízaga, Jaime
Gómez-Blázquez, Iván
Alfonso, Fernando
García del Blanco, Bruno
Sanchis Forés, Juan
author_role author
author2 Ariza Solé, Albert
Andrés Bermeo, Juan
Formiga Pérez, Francesc
Bueno, Héctor
Miñana, Gemma
Alegre Canals, Oriol
Martí, David
Martínez-Sellés, Manuel
Domínguez-Pérez, Laura
Díez Villanueva, Pablo
Barrabés, José A.
Marín, Francisco
Villa, Adolfo
Sanmartín-Fernández, Marcelo
Llibre, Cinta
Sionis, Alessandro
Carol, Antoni
García Blas, Sergio
Morales Gallardo, María José
Elízaga, Jaime
Gómez-Blázquez, Iván
Alfonso, Fernando
García del Blanco, Bruno
Sanchis Forés, Juan
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Fragilitat
Persones grans
Infart de miocardi
Brittleness
Older people
Myocardial infarction
topic Fragilitat
Persones grans
Infart de miocardi
Brittleness
Older people
Myocardial infarction
description Abstract: Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-STsegment 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 readmissions (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 causes 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, there 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 invasive strategy does not improve outcomes and might be harmful to the frailest patients.
publishDate 2024
dc.date.none.fl_str_mv 2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/219622
url https://hdl.handle.net/2445/219622
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.26599/1671-5411.2024.10.005
Journal of Geriatric Cardiology, 2024, vol. 21, num.10, p. 954-961
https://doi.org/10.26599/1671-5411.2024.10.005
dc.rights.none.fl_str_mv (c) Journal of Geriatric Cardiology, 2024
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Journal of Geriatric Cardiology, 2024
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Tsinghua University Press
publisher.none.fl_str_mv Tsinghua University Press
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,198674

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