Supplementary Material for: Prevalence and impact of frailty in patients ≥70 years old with acute coronary syndrome referred for coronary angiography

Introduction
Elderly patients with acute coronary syndrome (ACS) have a higher risk of adverse cardiovascular events and may be frail but are underrepresented in clinical trials. Previous studies have proposed that frailty assessment is a better tool than chronological age, in assessing older patients’ biological age, and may exceed conventional risk scores in predicting prognosis. Therefore, we wanted to investigate prevalence and impact on 12-month outcomes of frailty in patients ≥70 years with ACS referred for coronary angiography (CAG).

Methods
Patients ≥70 years with ACS referred for CAG underwent frailty scoring with the clinical frailty scale (CFS). Patients were divided into three groups depending on their CFS: Robust (1-3), Vulnerable (4) and Frail (5-9) and followed for 12 months.

Results
Of 455 patients, 69 (15%) patients were frail, 79 (17%) were vulnerable and 307 (68%) were robust. Frail patients were older (frail: 80.9±5.7 years, vulnerable: 78.5±5.5 years and robust 76.6±4.9 years, p<0.001) and less often treated with percutaneous coronary intervention (frail: 56.5%, vulnerable: 53.2% and robust: 68.6%, p=0.014). 12-month mortality was higher among frail patients (frail: 24.6%, vulnerable: 21.8% and robust: 6.2%, p<0.001). Frailty was associated with a higher mortality after adjustment for age, sex, comorbidities, GRACE score and revascularisation (HR 2.67, 95%CI 1.30-5.50, p=0.008). There was no difference between GRACE and CFS in predicting 12-month mortality (p=0.893).

Conclusions
15% of patients ≥70 years with ACS referred for CAG are frail. Frail patients have significantly higher 12-month mortality. GRACE and CFS are similar in predicting 12-month mortality.