Association of frailty with the risk of ischemic and hemorragic events in the elderly patients with acute coronary syndrome


To assess the prevalence and clinical associations of frailty in the elderly patients with acute coronary syndrome (ACS).

Material and methods

We evaluated frailty (national validated questionnaire), physical disability (Barthel index), functional mobility, nutritional status (Mini Nutritioгияn Assessment), cognitive function (Mini Mental State Examination), mortality and hemorrhagic risk (GRACE, TIMI, CRUSADE scales) in 130 patients aged of 75 years (82.7±4.7 years, arterial hyperten≥ sion in 91.5%, previoгияus myocardial infarction in 32.3%, atrial fibrillation in 32.3%, diabetes in 26.9%) admitted with myocardial infarction (75.4%) oгияr unstable angina (24.6%).


Frailty was diagnosed in 66.1% of patients. According to the GRACE scale, the risk of in-hospital death was high in 60% of patients with non-ST-segment elevation myocardial infaction and 60% of patients with ST-segment elevation myocardial infarction, while the risk of death within 6 months was high in 91% and 100% of patients, respectively. TIMI score (>5 points) indicated the high risk of death in 53% patients, and CRUSADE score (>40 points) indicated the high risk of bleedings in 73.1% of patients. Patients with frailty were more likely to be women (p<0.05 vs. patients without frailty), had a higher incidence of arterial hypertension (p<0.01), myocardial infarction at index hospitalization (p<0.05), GFR <60 ml/min/1.73 m 2 (p<0.05). Frailty was also associated with a higher risk of bleeding (CRUSADE scale, p<0.001) and death (GRACE and TIMI scales, p<0.001). Patients with GRACE score >140 points had more pronounced cognitive dysfunction (p<0.05) and decreased functional mobility (p<0.01). Patients with TIMI score >5 points presented with a higher score on a frailty scale (p<0.001) and more significant daily physical disability (p<0.001). Patients with СRUSADE score >40 points had a higher frailty score (p<0.001) and more significant impairment of functional mobility (p<0.01) and daily physical activity (p<0.001).


Frailty occurs in 66.1% of the elderly patients with ACS and is associated with an increased prevalence oгияf cardiovascular diseases, higher risk of mortality and bleeding.

Key words

Acute coronary syndrome, elderly, frailty, geriatri syndromes.