Invasive strategy and frailty in very elderly patients with acute coronary syndromes.

Isaac Llaó, Albert Ariza-Solé, Juan Sanchis, Oriol Alegre, Ramon López-Palop, Francesc Formiga, Francisco Marín, María T Vidán, Manuel Martínez-Sellés, Alessandro Sionis, Miguel Vives-Borrás, Joan Antoni Gómez-Hospital, Josep Gómez-Lara, Gerard Roura, Pablo Díez-Villanueva, Iván Núñez-Gil, Jaume Maristany, Lluis Asmarats, Héctor Bueno, Emad Abu-Assi, Àngel Cequier

Current guidelines recommend an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment was performed during hospitalization, including frailty. We evaluated the impact of an invasive strategy during the admission on the incidence of cardiac death, reinfarction or new revascularisation at 6-months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had lower proportion of frailty (23.3% vs 40.3%, p<0.001). The incidence of cardiac events was more common in patients managed conservatively, after adjusting for confounding factors (sub-Hazard ratio (sHR) 2.32, 95% confidence interval (CI) 1.26-4.29, p=0.007). This association remained significant in non-frail patients (sHR 3.85, 95% CI 2.13-6.95, p=0.001), but was not significant in patients with established frailty criteria (sHR 1.40, 95% CI 0.72-2.75, p=0.325). The interaction invasive strategy-frailty was significant (p=0.032) Conclusions: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.