Supplementary Material for: The Role of Frailty in Acute Coronary Syndromes in the Elderly

Background: Myocardial infarction (MI) patients are increasingly older, and common risk scores include chronological age, but do not consider chronic comorbidity or biological age. Frailty status reflects these variables and may be independently correlated with prognosis in this setting. Objective: This study investigated the impact of frailty on the prognosis of elderly patients admitted due to MI. Methods: This prospective and observational study included patients ≥75 years admitted to three tertiary hospitals in Spain due to MI. Frailty assessment was performed at admission using the Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the composite of death or non-fatal reinfarction during a follow-up of 1 year. Overall mortality, reinfarction, the composite of death, reinfarction and stroke, major bleeding, and readmission rates were also explored. Results: A total of 285 patients were enrolled. Frail patients (109, 38.2%) were older, with a higher score in the Charlson Comorbidity Index and with a higher risk score addressed in the GRACE and CRUSADE indexes. On multivariate analysis including GRACE, CRUSADE, maximum creatinine level, culprit lesion revascularization, complete revascularization, and dual antiplatelet therapy at discharge, frailty was an independent predictor of the composite of death and reinfarction (2.81, 95% CI 1.16–6.78) and overall mortality (3.07, 95% CI 1.35–6.98). Conclusion: Frailty is an independent prognostic marker of the composite of mortality and reinfarction and of overall mortality in patients aged ≥75 years admitted due to MI.

背景：心肌梗死（Myocardial infarction, MI）患者群体日益老龄化，临床常用的风险评分仅纳入实际年龄，未考虑慢性合并症与生物学年龄。衰弱状态可反映上述两类变量，且在该人群中可能与预后存在独立相关性。
目的：本研究探讨衰弱状态对因心肌梗死住院的老年患者预后的影响。
方法：本项前瞻性观察性研究纳入了西班牙3家三级医院中年龄≥75岁、因心肌梗死住院的患者。入院时采用欧洲健康、老龄化与退休调查衰弱指数（Survey of Health, Ageing and Retirement in Europe Frailty Index, SHARE-FI）工具完成衰弱评估。本研究的主要终点为1年随访期内死亡或非致死性再梗死的复合终点；同时还探索了全因死亡率、再梗死率、死亡/再梗死/卒中复合终点、大出血发生率以及再住院率。
结果：本研究共纳入285例患者。其中衰弱患者109例，占比38.2%，这类患者年龄更高，查尔森合并症指数（Charlson Comorbidity Index）评分更高，且GRACE与CRUSADE风险评分也处于更高水平。在纳入GRACE评分、CRUSADE评分、最高肌酐水平、罪犯病变血运重建、完全血运重建以及出院时双联抗血小板治疗的多变量分析中，衰弱状态是死亡与再梗死复合终点（比值比2.81，95%置信区间1.16–6.78）及全因死亡率（比值比3.07，95%置信区间1.35–6.98）的独立预测因素。
结论：对于因心肌梗死住院的≥75岁患者，衰弱状态是死亡与再梗死复合终点及全因死亡率的独立预后标志物。