Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-05-14 DOI:10.1111/jgs.19508

Lajjaben Patel, Matthew W. Segar, Muhammad S. Usman, Ritika Dhruve, Neil Keshvani, Alexander Postalian, Amgad Mentias, Craig D. Rubin, Kershaw V. Patel, Dharam J. Kumbhani, Subhash Banerjee, Ambarish Pandey

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引用次数: 0

Abstract

Background

Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.

Methods

A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).

Results

Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (P _interactionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (P _interactionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.

Conclusion

Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.

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查看原文本刊更多论文

慢性冠状动脉疾病初始侵入策略的衰弱、负担和疗效：缺血试验。

背景：虚弱在慢性冠状动脉疾病患者中很常见，并且与较差的预后相关。方法：对缺血和缺血- ckd试验进行汇总、事后分析。基线虚弱使用虚弱指数（FI）进行评估，参与者被分类为数据派生的分类。构建具有多重相互作用项（虚弱×治疗组）的多变量Cox模型，以评估基线虚弱状态是否改变了初始侵入（与保守）策略对心血管死亡、心肌梗死、不稳定心绞痛住院、心力衰竭或复苏性心脏骤停的复合结局和HRQoL的次要结局的治疗效果（西雅图心绞痛问卷[SAQ]）。结果：在5322名参与者（平均64岁，24%女性）中，高虚弱负担（3对1）与较低的基线SAQ评分和随访时不良临床结果的风险增加相关。基线虚弱负担并没有显著改变初始侵入策略对主要综合结局的影响（pinteraction羸弱×干预组= 0.30）。然而，虚弱显著改变了初始侵入策略对HRQoL的影响，初始侵入治疗（与保守治疗相比）1年时，更高的基线虚弱负担与更大的SAQ评分改善相关（pinteraction羸弱×干预组）。具有较高虚弱负担的慢性冠状动脉疾病患者更有可能通过初始侵入性治疗获得更大的HRQoL改善，而没有较高的不良临床事件风险。较低的基线SAQ评分预示着初始侵入性治疗后HRQoL的改善更大，与虚弱负担无关。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.