Revista española de cardiología (English ed.)最新文献

{"title":"Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO.","authors":"Daniel Enríquez-Vázquez, Eduardo Barge-Caballero, Francisco González-Vílchez, Luis Almenar-Bonet, María Dolores García-Cosío Carmena, José González-Costello, Manuel Gómez-Bueno, María Ángeles Castel-Lavilla, Beatriz Díaz-Molina, Manuel Martínez-Sellés, Sonia Mirabet-Pérez, Luis de la Fuente-Galán, Daniela Hervás-Sotomayor, Diego Rangel-Sousa, Iris P Garrido-Bravo, Teresa Blasco-Peiró, Gregorio Rábago Juan-Aracil, Javier Muñiz, María G Crespo-Leiro","doi":"10.1016/j.rec.2024.09.005","DOIUrl":"10.1016/j.rec.2024.09.005","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression.</p><p><strong>Results: </strong>Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n=112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P=.025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P=.003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P=.007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P=.042). No significant differences were found between groups regarding other postoperative complications.</p><p><strong>Conclusions: </strong>Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic role of persistent angina after percutaneous revascularization in chronic coronary syndrome with altered angiography and stress CMR.","authors":"Nerea Pérez-Solé, Elena de Dios, José V Monmeneu, María P López-Lereu, José Gavara, César Ríos-Navarro, Víctor Marcos-Garces, Héctor Merenciano, Clara Bonanad, Joaquim Cánoves, Félix Platero, Andrea Ventura, David Moratal, Antoni Bayés-Genís, Jorge Sanz, Manuel Jiménez-Navarro, Luis Martínez-Dolz, Juan Sanchis, Julio Núñez, Vicente Bodí","doi":"10.1016/j.rec.2024.09.004","DOIUrl":"10.1016/j.rec.2024.09.004","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>In patients with established chronic coronary syndrome (CCS), the significance of persistent angina is controversial. We aimed to evaluate the prognostic role of persistent angina in symptomatic CCS patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiographic findings undergoing percutaneous revascularization.</p><p><strong>Methods: </strong>We analyzed 334 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficits on stress CMR and severe lesions in angiography who underwent medical therapy optimization plus CMR-guided percutaneous revascularization. We investigated the association of persistent angina at 6 months postintervention with subsequent cardiac death, myocardial infarction, and hospital admission.</p><p><strong>Results: </strong>All patients had angina class ≥2 (mean: 2.8±0.7), abnormal stress CMR (mean ischemic burden: 5.8±2.7 segments), and severe angiographic lesions. The angina resolution rates were 81% at 6 months, and 81%, 81%, and 77% at 1, 2, and 5 years, respectively. During a median follow-up of 8.9 years, persistent angina was independently associated with higher rates of subsequent cardiac death (13% vs 4%; HR, 3.7; 95%CI, 1.5-9.2; P=.005), myocardial infarction (24% vs 6%; HR, 4.9; 95%CI, 2.4-9.9; P<.001), and hospital admission for heart failure (27% vs 13%; HR, 2.7; 95%CI, 1.5-5.2; P=.001).</p><p><strong>Conclusions: </strong>In CCS patients with robust diagnostic evidence from symptoms, stress CMR, and angiography, persistent angina after percutaneous revascularization is a strong predictor of subsequent cardiac death, myocardial infarction, and hospital admission for heart failure.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in precision nutrition and cardiometabolic diseases.","authors":"Miguel A Martínez-González, Francisco J Planes, Miguel Ruiz-Canela, Estefanía Toledo, Ramón Estruch, Jordi Salas-Salvadó, Rafael Valdés-Más, Pedro Mena, Olga Castañer, Montse Fitó, Clary Clish, Rikard Landberg, Clemens Wittenbecher, Liming Liang, Marta Guasch-Ferré, Rosa M Lamuela-Raventós, Dong D Wang, Nita Forouhi, Cristina Razquin, Frank B Hu","doi":"10.1016/j.rec.2024.09.003","DOIUrl":"10.1016/j.rec.2024.09.003","url":null,"abstract":"<p><p>A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of visceral adiposity on long-term mortality in patients undergoing coronary artery bypass grafting.","authors":"Jinhwan Jo, Seung Hun Lee, Jeong Hoon Yang, Sung Mok Kim, Ki Hong Choi, Young Bin Song, Dong Seop Jeong, Joo Myung Lee, Taek Kyu Park, Joo-Yong Hahn, Seung-Hyuk Choi, Su Ryeun Chung, Yang Hyun Cho, Kiick Sung, Wook Sung Kim, Hyeon-Cheol Gwon, Young Tak Lee","doi":"10.1016/j.rec.2024.09.002","DOIUrl":"10.1016/j.rec.2024.09.002","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat.</p><p><strong>Methods: </strong>A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm²)/height² (m²) at the L3 level. The primary outcome was all-cause mortality during follow-up.</p><p><strong>Results: </strong>Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis.</p><p><strong>Conclusions: </strong>Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spanish cardiac catheterization and coronary intervention registry. 33rd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2023)","authors":"Teresa Bastante ,&nbsp;Dabit Arzamendi ,&nbsp;Javier Martín-Moreiras ,&nbsp;Ana Belén Cid Álvarez ,&nbsp;en representación de la ACI-SEC ,&nbsp;Julio Carballo Garrido ,&nbsp;Leire Andraka ,&nbsp;Alfredo Gómez Jaume ,&nbsp;Álvaro Merino Otermin ,&nbsp;Miguel Artáiz Urdaci ,&nbsp;Rafael Ruiz Salmerón ,&nbsp;Armando Pérez de Prado ,&nbsp;Ignacio Cruz González ,&nbsp;Ramon Calviño Santos ,&nbsp;Jeremías Bayón ,&nbsp;Ramiro Trillo ,&nbsp;José Antonio Baz ,&nbsp;Alberto Berenguer ,&nbsp;Juan M. Casanova Sandoval ,&nbsp;Salvador Álvarez Antón ,&nbsp;Mariano Larman","doi":"10.1016/j.rec.2024.07.015","DOIUrl":"10.1016/j.rec.2024.07.015","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>This article presents the 2023 activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC).</div></div><div><h3>Methods</h3><div>All interventional cardiology laboratories in Spain were invited to participate in an online survey. Data analysis was carried out by an external company and subsequently reviewed and presented by the members of the ACI-SEC board.</div></div><div><h3>Results</h3><div>A total of 119 hospitals participated. The number of diagnostic studies decreased by 1.8%, while the number of percutaneous coronary interventions (PCI) showed a slight increase. There was a reduction in the number of stents used and an increase in the use of drug-coated balloons. The use of intracoronary diagnostic techniques remained stable. For the first time, data on PCI guided by intracoronary imaging was reported, showing a 10% usage rate in Spain. Techniques for plaque modification continued to grow. Primary PCI increased, becoming the predominant treatment for myocardial infarction (97%). Noncoronary structural procedures continued their upward trend. Notably, the number of left atrial appendage closures, patent foramen ovale closures, and tricuspid valve interventions grew in 2023. There was also a significant increase in interventions for acute pulmonary embolism.</div></div><div><h3>Conclusions</h3><div>The 2023 Spanish cardiac catheterization and coronary intervention registry indicates a stabilization in coronary interventions, together with an increase in complexity. There was consistent growth in procedures for both valvular and nonvalvular structural heart diseases.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"77 11","pages":"Pages 936-946"},"PeriodicalIF":7.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous coronary intervention and TAVR: the simpler the better.","authors":"Manel Sabaté","doi":"10.1016/j.rec.2024.08.008","DOIUrl":"10.1016/j.rec.2024.08.008","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter pulmonary valve replacement for the treatment of carcinoid heart disease.","authors":"Gaspard Suc, Agnes Cachier, Sebastien Hascoet, Dimitri Arangalage, Bernard Iung, Marina Urena","doi":"10.1016/j.rec.2024.09.001","DOIUrl":"10.1016/j.rec.2024.09.001","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The European Society of Cardiology quality indicators in atrial fibrillation in centers of excellence in Spain: the SEC-EXCELENTE FA registry.","authors":"Martín Ruiz Ortiz, Elena Arbelo, Inmaculada Roldán Rabadán, Francisco Marín, Alejandro Pérez Cabeza, Raquel Marzoa Rivas, Rafael Peinado Peinado, Almudena Valle Alberca, Alicia Ibáñez Criado, Alfonso Valle Muñoz, Joaquín Osca Asensi, Ana Del Río Lechuga, Francisco Javier Elola Somoza, Manuel Anguita Sánchez, Martín Ruiz Ortiz, Rafael Peinado Peinado, Elena Arbelo Laínez, Almudena Valle Alberca, Alicia Ibáñez Criado, Alfonso Valle Muñoz, Joaquín Osca Asensi, Ana Del Río Lechuga, Alejandro I Pérez Cabeza","doi":"10.1016/j.rec.2024.08.007","DOIUrl":"10.1016/j.rec.2024.08.007","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>By 2022, 9 centers had been accredited by the Spanish Society of Cardiology for the atrial fibrillation (AF) process. Our objective was to evaluate the performance of these centers based on the quality indicators (QIs) proposed by the European Society of Cardiology (ESC) in 2020.</p><p><strong>Methods: </strong>Adults with AF who were attended in the cardiology departments of participating centers during the second week of May 2019 were included in a retrospective registry (n=797, age 72±11 years, 60% male). Key ESC QIs were assessed.</p><p><strong>Results: </strong>CHA₂DS₂-VASc, HAS-BLED scores, and serum creatinine levels were documented in 24.9%, 6.1%, and 96.2% of patients, respectively. Anticoagulation was appropriately prescribed in 90.6% of high-risk patients according to the CHA₂DS₂-VASc score, but was inappropriately prescribed in 57.8% of low-risk patients. Among all patients, 84.1% received high-quality anticoagulation. Inappropriate antiarrhythmic drugs were prescribed in 7.2% of patients with permanent AF, 2.9% of those with structural heart disease, and 0.0% of those with end-stage kidney disease. Catheter ablation was offered to 70% of patients with symptomatic paroxysmal or persistent AF after the failure or intolerance of 1 antiarrhythmic drug. All modifiable risk factors were documented in 59.3% of patients. Rates of all-cause mortality, ischemic stroke or transient ischemic attack, and major bleeding were 8.1, 0.8, and 2.56 per 100 patients/y, respectively. QIs for anticoagulation and outcomes were similar between general cardiology and tertiary referral centers.</p><p><strong>Conclusions: </strong>Although accredited centers in Spain demonstrated good performance in many of the ESC QIs for AF, there remains room for improvement. These data could serve as a starting point for enhancing the quality of care in this population.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"J-shaped association between apolipoprotein B and CV outcomes in statin-treated patients with chronic coronary syndrome.","authors":"Jining He, Zhangyu Lin, Chenxi Song, Sheng Yuan, Xiaohui Bian, Bowen Li, Wenjun Ma, Kefei Dou","doi":"10.1016/j.rec.2024.08.004","DOIUrl":"10.1016/j.rec.2024.08.004","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The association between apolipoprotein B (apoB) and residual cardiovascular (CV) risk in patients with chronic coronary syndrome (CCS) remains unclear. We aimed to investigate the association between apoB levels and CV outcomes in statin-treated CCS patients.</p><p><strong>Methods: </strong>We enrolled 8641 statin-treated CCS patients at Fuwai Hospital. The patients were divided into 5 groups based on to apoB quintiles (Q1 to Q5). The primary endpoint was 3-year CV events, including CV death, nonfatal myocardial infarction, and nonfatal stroke.</p><p><strong>Results: </strong>During a median follow-up of 3.17 years, there were 232 (2.7%) CV events. After multivariable adjustment, a restricted cubic spline illustrated a J-shaped relationship between apoB levels and 3-year CV events, with the risk remaining flat until apoB levels exceeded 0.73g/L, after which the risk increased (nonlinear P <.05). Kaplan-Meier curves showed the lowest CV event rate in the Q3 group (0.68-0.78g/L). Compared with the Q3 group, multivariable Cox regression models revealed that both low (Q1, ≤0.57g/L) and high (Q5, >0.93g/L) apoB levels were associated with an increased risk of major adverse cardiac events (all P <.05). Notably, patients with low apoB levels (Q1) had the highest risk of CV death (HR, 2.44; 95%CI, 1.17-5.08).</p><p><strong>Conclusions: </strong>Our analysis indicates that both low and high levels of apoB are associated with elevated CV risk, with the risk being particularly pronounced at higher levels (> 0.73g/L).</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric conditions and invasive management in frail patients with NSTEMI. A subgroup analysis of a randomized clinical trial.","authors":"Juan Sanchis, Héctor Bueno, Sergio García-Blas, Joan A Gómez-Hospital, David Martí, Manuel Martínez-Sellés, Laura Domínguez-Pérez, Pablo Díez-Villanueva, José A Barrabés, Francisco Marín, Adolfo Villa, Marcelo Sanmartín, Cinta Llibre, Alessandro Sionis, Antoni Carol, Ernesto Valero, Elena Calvo, María José Morales, Jaime Elízaga, Iván Gómez, Fernando Alfonso, Bruno García Del Blanco, Francesc Formiga, Eduardo Núñez, Julio Núñez, Albert Ariza-Solé","doi":"10.1016/j.rec.2024.08.006","DOIUrl":"10.1016/j.rec.2024.08.006","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Invasive management in frail patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains controversial. We investigated the impact of various geriatric conditions.</p><p><strong>Methods: </strong>The MOSCA-FRAIL trial included 167 adults aged ≥ 70 years with frailty (Clinical Frailty Scale [CFS] ≥ 4 points) and NSTEMI, who were randomized to either an invasive (n=84) or conservative (n=83) strategy. In addition to frailty, we measured activities of daily living (Barthel index), cognitive impairment (Pfeiffer test), and comorbidities (Charlson index). The primary endpoint was the difference (invasive minus conservative) in restricted mean survival time (RMST) for all-cause mortality at a median follow-up of 3.9 years.</p><p><strong>Results: </strong>A total of 93 patients died. The RMST difference favored invasive management at the CFS 25th percentile (CFS=4; 157 days, 95%CI, 18-295; P=.027), which changed to a nonsignificant effect at the 50th and 75th percentiles. The RMST difference remained nonsignificant, irrespective of the severity of other geriatric assessments. In time-to-event analysis, invasive management was associated with an initially lower life expectancy, peaking at around 1 year, among all subgroups. However, patients with CFS=4 experienced a benefit at the end of follow-up (181 days, 95%CI, 19-343), whereas those with CFS >4 did not (-16 days, 95%CI, -217 to 186; interaction P=.16). Subgroups defined by other geriatric markers showed a similar time-dependent trend, albeit with weaker statistical interaction.</p><p><strong>Conclusions: </strong>Among adults with frailty and NSTEMI, the CFS might be useful for evaluating the relative risks and benefits of invasive management. A CFS >4 could serve as a valuable threshold for decision-making.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}