The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Coronary artery lesion phenotype in frail older patients with non-ST-elevation acute coronary syndrome undergoing invasive care

EuroIntervention 2019;15:e261-e268. DOI: 10.4244/EIJ-D-18-00848

1. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; 2. Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA; 3. Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; 4. Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom; 5. Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; 6. Department of Biochemistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom; 7. Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 8. Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom; 9. Cardiovascular Research Foundation, New York, NY, USA

Aims: The association of frailty with coronary plaque phenotype among older patients with non-ST-elevation acute coronary syndrome (NSTEACS) is not known. The aim of this study was to evaluate the association of frailty with coronary plaque phenotype among older patients with NSTEACS.

Methods and results: Older patients with NSTEACS who underwent invasive angiography were recruited. Frailty was measured using the Fried frailty score. Following angiography, patients underwent greyscale and virtual histology intravascular ultrasound (VH-IVUS) imaging. Of the 90 patients, 26 (28.9%) were robust, 49 (54.4%) patients were pre-frail, and 15 (16.7%) were frail. Mean age was 80.9±3.8 years; 59 (65.6%) were male. Compared to robust patients, the pre-frail group had a significantly greater presence of high-risk lesions including VH thin-cap fibroatheroma (TCFA, p=0.011), minimum lumen area (MLA) ≤4 mm2 (p=0.016), TCFA+MLA ≤4 mm2 (p=0.005), TCFA+plaque burden (PB) ≥70% (p=0.005) and TCFA+PB ≥70%+MLA ≤4 mm2 (p=0.003). By age- and sex-adjusted logistic regression analysis, frailty was found to be strongly and independently associated with the presence of TCFA (odds ratio [OR] 2.81, 95% confidence interval [CI]:1.06-7.48, p=0.039).

Conclusions: This is the first study to report the relationship between frailty phenotype and coronary plaque morphology among frail older NSTEACS patients. ClinicalTrials.gov Identifier: NCT01933581

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